60 Minutes: Mental Healthcare Denial
Two years after the tragedy at Sandy Hook Elementary School, 60 Minutes looked at the state of mental health in America. The killer in that mass shooting was found to have had mental illness, but his parents’ attempts to get him treatment were denied by a health insurance provider at least once.
This led 60 Minutes and Scott Pelley to explore the stories of parents who battle to get needed psychiatric care for their children. Though they concluded that a majority of claims were routine, they also found that insurance companies were aggressive about reviewing claims involving patients with chronic cases.
Apparently, insurance company doctors can deny claims and care without ever meeting a patient. This can lead to seriously ill and potentially dangerous patients being released onto the streets, regardless of psychiatrists’ concerns about the consequences.
60 Minutes: Bulimia, Depression & Heart Failure
By the age of 14, Katherine West was purging her food. Doctors told her mom that her Bulimia was caused by Depression. Mother Nancy recalled that her daughter had been cutting by the age of 12. Physicians recommended that she be monitored 24 hours a day, a treatment that would cost $50,000 for 12 weeks. But the insurance company stopped paying after half that time.
“You don’t cure a mental illness in six weeks,” Nancy said. The company that stopped paying was Anthem, the nation’s second largest health insurance provider. Since Katherine had put on enough weight, an insurance company doctor decided she was good to go, despite objections from her doctor at the hospital, who was concerned about Katherine’s desperation to lose the pounds she had gained.
Katherine was released for outpatient care. She died soon afterward at the age of 15, due to Heart Failure because she had begun purging again. Nancy did not understand why someone who never even observed her daughter was allowed to make a decision that led to her death, against the recommendations of a team of medical professionals who did interact with her.
60 Minutes: Child Mind Institute
When a patient like Katherine is admitted, a representative for the insurance company will call the doctor regularly to monitor the patient’s progress. Once that rep decides a patient is ready for less extensive care, the case is referred to a company doctor for a review and a judgment. 60 Minutes found that in most cases, the judgment is a denial of coverage.
This also happened to Jacob Moreno in 2012. After he was denied continued hospitalization due to his stated desire to kill people, he ran naked in the street, approaching strangers and going after a police officer. Once he was subdued by a Taser, the state mandated that he return to a mental hospital.
Another patient, Richard Traiman, said as he was discharged that he would jump off a bridge; instead, he hung himself one day later. Dr Harold Koplewicz, founder of the Child Mind Institute, refers to insurance companies’ managed care programs as “really managed cost.” He recalled battling with insurance company employees on the phone on a regular basis.
60 Minutes: Denial of Coverage
When Dr Koplewicz would seek approval to keep a patient for five days, he would get pushback, since the patient was not homicidal or suicidal, since he or she did not have access to weapons within the hospital. But in a home setting or outside of that controlled environment, all bets were off. “It’s a lot cheaper in the short run,” Koplewicz said, though it hurts patients, their families, and society.
60 Minutes also shared the story of a patient named Ashley, who has Bipolar Disorder and had a suicide attempt in 2012. Her mother, Maria, got the call about this attempt, her fourth in a single year. Though her parents had done their best to remove harmful objects, Ashley broke her cell phone and used the glass to cut her wrists.
Anthem, her insurance company, suggested treatment at Timberline Knolls, and a doctor prescribed a 90-day stay. Ashley traveled from Illinois to California for the treatment, only to be put on the street by her insurance company after less than a week. Maria’s only other option was to pay $22,000 for the rest of a month’s stay, which was not affordable.
60 Minutes: Dr Tim Jack “Dr Denial”
But how was Ashley’s care denied? A log obtained by 60 Minutes showed the work of Dr Tim Jack, an Anthem psychiatrist, who attempted to call Ashley’s doctor three times in just over 30 minutes. When he left messages that were unreturned after under one hour, her coverage was denied, even though the insurance company never spoke with her doctor before making that determination.
In many cases, insurance doctors like Dr Jack are paid by the case, so they have an incentive to rush through their work. Dr Jack received $45 per patient, and according to court records, he reviewed 550 cases per month, making $25,000 to put countless lives in danger.
60 Minutes found that he had a reputation in the psychiatric community and had earned the nickname Dr Denial. 60 Minutes reviewed records and found that Dr Jack’s denial rate was 92% over a six-month period in 2011. What’s worse is that this was a typical rate for 11 Anthem reviewers in 60 Minutes’ research.
60 Minutes: Suing Insurance Companies
Kathryn Trepinski, a lawyer for patients and their families, has filed suit against Anthem and other insurance companies. These people are left to pick up the pieces, dealing with trauma firsthand or attempting to cover tens of thousands of dollars in care out of pocket. Though Anthem claimed these reviews are checked by a supervisor, in Ashley’s case, Dr Jack acted as his own supervisor.
“It suggests a layer of review that is not there,” Trepinski said. Unsurprisingly, Dr Jack declined 60 Minutes’ repeated attempts to get his side of the story. The families of Katherine West and Ashley allowed the show to question Anthem about their cases, which resulted in a statement that they were provided “numerous care options that went beyond their covered benefits.”
Former Anthem California medical director Dr Paul Keith retired in March 2014. His job used to involve supervising doctors who performed the reviews. His contention is that healthcare providers often abuse insurance companies, creating an “adversarial relationship,” dismissing the idea that discharging patients resulted in “some terrible consequence.”
60 Minutes: Insurance Companies Saving Money
Dr Keith also seemed to cast blame on parents of patients, who probably have a lot going on when a child is in psychiatric care in a hospital. “Parents become fearful…, but you can’t keep an individual in the hospital forever,” he said, adding that “money is not the basis for the decision.” Do you believe this guy?
Granted, these interviews are edited, but Scott Pelley seemed to let Dr Keith continue digging a hole as he claimed that this is all done so insurance companies can save patients money. Ashley’s family, meanwhile, appealed to the California Insurance Board, succeeding in getting her denial reversed. Now she is being treated for Bipolar Disorder.
Katherine West was buried in December 2013, and her mother is suing Anthem. 60 Minutes also shared a portion of an upcoming Connecticut mental health report from the Sandy Hook Commission, which cites insurance review as “a formidable barrier to care,” calling for state review of all denials. What do you think would help to change or improve this equation?