Perhaps one of the biggest hurdles people who struggle with a mental disorder struggle with is insurance. Insurance companies have become a major contributing factor to why healthcare is not possible for most American citizens. Not only are there high out-of-pocket costs for non-covered treatment, but sometimes major insurance companies will refuse to cover life-saving care, often deciding that mental health is not considered ‘real’ health and is thus not necessary. Without insurance-covered treatments, many people are left without the treatment and medication they need to recover and live happy, fulfilling lives.
Another big problem is the sheer amount of fraud that is often committed in the insurance world and is often not punished appropriately when caught. This lets big companies believe they can get away with anything and are constantly looking for ways to make more money to the detriment of the people they are supposed to serve.
In California, there is a new bill is in the state senate called SB999. This bill will be able to hold these companies accountable for their actions. This may be the start of a movement that can make its way to Washington if enough support is given, but what is it? And what does it do?
What Are These Bad Practices?
Insurance companies have a bad reputation and for several good reasons. The most often complained about and often criminal behaviors employed by insurance companies are:
- Denying life-saving care to increase profits, thus pleasing shareholders and investors that can easily afford health care.
- Denying coverage to certain facilities, often as ‘punishments’ for pushing back against bad practices.
- Denying coverage without the input of a health care professional.
- Charging expensive rates and then refusing to pay out claims.
These problems affect the health of the nation and its people, and should not be tolerated.
What Is Bill SB999?
Bill SB999 is a continuation of the Knox-Keene Health Care Service Plan Act of 1975, which requires health care service plans to be licensed and regulated by the Department of Managed Health Care. Any willful violations of these requirements make it a crime. It also requires health insurers to be regulated. Health care service plans and disability insurers are required to base their coverage on medical necessity determinations, including coverage for the following:
- treatment
- the diagnosis process
- prevention of mental health disorders
- prevention of substance abuse disorders
What is determined as medically necessary is often left to the decision of those who are not in the medical field, and look instead at the costs of treatment compared to how much profit they gain by denying treatment. By denying coverage, it allows them to pocket insurance fees a person pays, only to never get it or have to fight to have their much-needed medical expenses covered. Sometimes the companies will only cover a small portion of the bare minimum required by law, thus leaving the person in dire need.
Bill SB999 requires all of the regulations demanded of the previous bill but takes away the loopholes insurance companies have been utilizing to get away with bad practices. This bill requires health care service plans and disability insurers. Individuals act on their behalf and comply with specific requirements to maintain access to a telephone during California business hours to allow healthcare providers to have direct contact with them. This allows an actual professional in the field to conduct discussions on treatments and directly request authorization for care. This will impose a state-mandated local program to make sure these plans and insurers do not break the law and will be accountable for what actions they take.
This bill will also require that some acts are not eligible for reimbursement from the state to local agencies and school districts, preventing the misuse of the reimbursement system.
What Does This Mean?
This means that if this bill passes, it will make it much easier for people to get the help they need and allow groups to hold insurance companies accountable. One such group is CURES, a group dedicated to making sure people get the health care they are entitled to regardless of how hard insurance companies try to discriminate. With the bill being proposed, professionals working on treating a substance abuse disorder can make use of CURES’ online prescription medication database, a real-time database doctors can use to prevent the abuse of controlled substances.
Alumni, those that have ‘graduated’ from treatments, are working on educating the public about mental health disorders and encouraging those that need it to seek treatment. Having this bill in discussion is bringing more awareness to those that struggle with mental health disorders, and how those that want help are often kicked aside by insurance companies. With more people who have been through the system rising to talk about their experiences, this may push this bill to Washington. Hopefully, with support, this bill may end up as federal law, and prevent insurance companies from taking advantage of the public.
It’s hard to find help for your mental health disorder, especially when insurance companies make it much more difficult than it has to be. This can cause feelings of stress and helplessness which in turn negatively impact your mental health.
Here at Acera Health in Costa Mesa, California, we are at the front lines fighting for your right to receive care free of discrimination. A medical professional should decide if you need treatment, not someone who has no idea what mental health is.
If you want more information about Bill SB999 and how to advocate for your or your loved ones’ right for the care you pay for, or if you or a loved one are struggling with your mental health, call (949)-866-3881 to speak with one of our compassionate and knowledgeable professionals. You deserve to be treated with respect and care, and we will fight for you.
Melody is a highly skilled proactive clinical administrator, with more than 17 years of experience serving the community in the behavioral health field.
Her clinical management career started in 2011 as a compliance manager and program director. In 2018, she became an executive as chief clinical officer (CCO). She is a seasoned licensed marriage & family therapist.
