More than 1 million Coloradans are affected by mental health conditions, yet many are being denied coverage for the care promised by their insurance policies, according to health advocates.
Jake Williams, CEO of Healthier Colorado, revealed that a significant number of claims for mental health treatment are rejected by insurers, who deem them “not medically necessary” despite a doctor’s recommendation. Williams stated that 75% of Coloradans with commercial insurance and a diagnosed mental health condition did not receive the necessary care in the past year, emphasizing the real-life impact on patients.
In 2008, Congress passed a law designed to ensure equal access to mental health and physical health care. However, a loophole in the law allows insurance companies to determine what treatments are considered “necessary or appropriate,” leading to widespread coverage denials.
A ProPublica investigation found that UnitedHealth Group had been using algorithms to deny claims, a practice that was later deemed illegal in three states. UnitedHealth defended the system, asserting it was aimed at ensuring that treatments were safe, effective, and affordable.
David Lloyd, chief policy officer of the mental health advocacy group Inseparable, argued that insurers should not be able to reject care based on criteria that diverge from established clinical standards. He called for both state and federal lawmakers to take action on the issue.
“We’re encouraging policymakers to take common-sense steps to make sure health plans cover the services they’ve committed to providing,” Lloyd said.
One potential solution is a new bill introduced in the Colorado General Assembly. The measure would require insurers to adopt criteria for mental health treatment based on guidelines from the American Academy of Child and Adolescent Psychiatry and the American Association for Community Psychiatry.
Williams expressed hope that the bill would create uniformity in mental health care access. “We want to establish a clear, standardized definition of medical necessity, so that insurers, patients, and doctors are aligned, and patients are more likely to get the critical services they need,” he said.
As the issue of insurance denials continues to affect thousands of Coloradans, lawmakers and advocacy groups are pushing for reforms that could ensure more equitable access to mental health care.
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