Insurance is limited when it comes to covering mental health, and those who need it continue to suffer.
It’s no secret that mental health care in the United States is in a troubling state. According to a recent report from the National Alliance on Mental Illness, nearly 60% of adults with a mental illness don’t receive treatment, and of those who do, only 38% receive care that is considered “minimally adequate.” One of the major reasons for this is that many people who need mental health care simply can’t afford it. In fact, a recent study found that nearly 30% of adults with serious mental illness are uninsured. With insurance limitations, the mental health stigma continues to be seen as a nice-to-have service rather than something that’s necessary and brushing it as something that’s not essential isn’t okay for those who desperately need it.
Jake, for example, needed treatment. He was a 15-year-old who struggled with severe depression and suicidal ideation. His parents wanted to help their son, but he was on their insurance and the company didn’t seem to care. Outpatient services weren’t helping, and Jake was hospitalized twice in one month. Yet, he was ultimately cut off from further treatment.
During his first hospitalization, Jake spent five days there before being admitted to an outpatient program as required by his parents’ insurance company. The program was not successful. He was hospitalized again almost immediately where he was kept for another five days. Then, on January 11, 2015, Jake died by suicide following a letter from the insurance company that it would no longer reimburse for care. He couldn’t receive it even though this directly contracted the recommendation of his doctors.
The insurer’s reason for cutting plan benefits? The service was: “Not medically necessary.” With those three simple words, Jake paid with his life.
In a ruling on February 28, 2019, in the case of Wit v. United Behavioral Health, a judge found that UBH (the biggest insurer in the nation) was wrong to use its internally developed standards for coverage instead of generally accepted clinical standards. This was the case in Jake’s situation. Even though outpatient services weren’t helping, the insurer insisted he be treated via this route instead of allowing for further inpatient care.
Wit v. United Behavioral Health was brought by a group of mental health patients who claimed that UBH was illegally denying them coverage for certain treatments. The court ruled in favor of the patients regarding the insurance limitations, but for Jake (and likely many others), the decision came too late.
Jake’s parents believe that had their son suffered a more “conventional” sickness, such as diabetes or a heart condition, insurance limitations wouldn’t be an issue and UBH wouldn’t have dictated that he be sent home. His hospitalization would have been prioritized. In this way, the case drives home the stigmatization that mental health continues to receive and just how far behind insurers are to keeping up with the changing times.
The Wit v. UBH ruling was ultimately reversed by three judges in the 9th Circuit Court of Appeals, and the most current decision, as it stands, means that those who need care likely won’t receive it. There is still time for the judges of the 9th Circuit to revisit this case, and Jake’s family is pushing for them to reconsider.