Locked Behind Door #1

JenniferInsurance-Related Challenges
In yesterday’s Expert Perspective, Ron Manderscheid outlined three common kinds of challenges to accessing mental health care: insurance-related, provider-related, and distance-related challenges. Over the next three days, we’ll hear personal stories from individuals who’ve experienced these roadblocks first-hand.

Today, we hear from Jennifer, who, like many of you, experienced insurance-related challenges first-hand.

 

Jennifer’s Story
Back in 1996, when I was struck with postpartum psychosis, there was still a separation of mental health insurance coverage and medical insurance coverage. This separation was devastating to my and my husband’s financial situation. It also exacerbated my condition.

After two hospitalizations, my lifetime mental health insurance benefit reached its maximum. The lifetime maximum for mental health coverage was considerably less than the maximum benefit for medical coverage. The question of why the diagnosis of postpartum psychosis was not considered a medical condition puzzled me. Here I was having to take prescription medication to stabilize me and help me get better, yet my insurance was telling me I did not have a medical condition.

How could this be happening? I anguished over my dilemma. I needed medical care yet I could not afford my medicine and visits to the medical professionals. I had insurance coverage but had never had to use it for anything other then my pregnancies. When I was in a crisis and needed the medical insurance, I discovered how limited the insurance coverage was for mental health.

My husband and I had to use our lifetime savings to pay for the medical expenses. We began the process of appealing the insurance company’s decision of not recognizing postpartum psychosis as a medical condition. My doctor recognized it as a medical condition, supporting us in our appeal process. But the process would involve hiring an attorney—additional costs, as well as additional stress and anxiety for me. I struggled with what to do as I did not feel recovered enough to take on the huge task of fighting an insurance company.

Our saving grace was when the contractor changed at my husband’s job. This enabled us to have new insurance coverage hence a new life-time maximum for mental health conditions. I was so thankful, but it should not have taken an employer change to get the insurance coverage needed. I would learn that such discrimination between medical and mental health coverage occurred for years.

Thankfully, later in 1996, the Mental Health Parity Act was passed. The Act required equal coverage with respect to aggregate lifetime and annual dollar limits for mental health benefits. Although this Act did not help me during my initial onset of postpartum psychosis, it would help me later in my recovery.

The question of why the insurance company did not recognize that postpartum psychosis was a medical condition remains unanswered for me. My hope is that we can eliminate the stigma often associated with mental health and continue to conduct more research supporting the fact that you can not separate mental health from physical health.

Your Turn
Does Jennifer’s story sound familiar? Comment below and let us know about your insurance-related challenges.

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