In my attempts to provide mental health and substance abuse treatment for adult men, I have uncovered a concerted effort by insurance providers to circumvent the funding for such treatment by ignoriing valid mental health and substance abuse claims which infact is something far worse than denying claims because by actually ignoring or not processing said valid claims you prevent any appeals and subsequent reimbursement by medicaid. This not processing is infact a actual violation of state law . Where the law clearly states that all valid claims must be processed either denied or approved within a reasonable amount of time. This violation of the law led to me filing a complaint against this provider with the state insurance commissioner. Their response being they had no actual jurisdiction over the insurance provider as they fell under federal jurisdiction as medicare and medicaid contractors. They offered to file a complaint on my behalf with the federal medicare board. The actual ignoring of the claim is far worse than simply denying it. A denial could be appealed and then turned over to medicaid for reimbursement. Since mental health and substance abuse treatment is mandated by the affordable care act the denying of these claims has no merit. So by just not processing the claim it results in the non funding of the treatment provider which serves as a extreme disservice to the clients who need treatment the most. With opioid deaths at a all time high as well as mental health caused mass death currently in the news. Not to mention the mental health and substance abuse caused homelessness at all time highs across the country. The need for more not less mental health and substance abuse treatment is clear and its the insurance providers service of their bottom line instead of their clients that demands our immediate attention. In my research I have uncovered that insurance providers recieve monthly alottments for each medicare and Medicaid client they cover. This alottment is provided whether the client uses the funds or not. Therefore it serves their bottom line to deny or ignore claims submitted on behalf of these clients. In speaking with an attorney that is famillar with these issues he stated the insurance providers have adopted the ignoring mental health and substance abuse claims as a policy as they will only pay when they are forced to through a law suit. In those cases they will pay the litigants and sign a non- disclosure agreement and ignore all the other claims they have denied or ignored. Thus preventing the flood gate of valid claims from being addressed. This is a actual company policy. This serves as a serious disservice to all those who suffer from mental health and substance abuse illness. It also serves as a disservice to the country as a community and all the hard work that went into passing the Affordable care act. We all our affected by the actions of the mentally unstable and serve witness to the extremely high tolls for opioid related deaths.
Our only action at this time to put the bright light of acknowledgement on the insurance industry. To scream with our loudest voicet of the injustice being extolled on those who suffer from mental health and substance abuse illness. We all are touched by this disservice in one way or another. If not us then whom , if not now then when. It remains the duty of those with a voice to speak on behalf of the voiceless. Helping someone other than myself is a mandate inwhich I have made a life mission. I would ask all those that feel the same to join me in proclaiming the disservice being orchestrated by the insurance companies and make an all-out effort to right this most serous wrong.
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