Insurance barriers

The Challenge: Insurance Barriers

Home ﹥ The challenge ﹥ Insurance barriers

Federal parity regulations were created to ensure that mental health and addiction treatment is covered the same as that for physical illness. However, loopholes exist that make it difficult for behavioral health patients to receive the level of care they need for recovery.

Narrowly defined networks make it hard for people to access mental healthcare, as people often face challenges identifying providers who will accept their insurance.

It is not unusual that an insurance policy sets a lifetime limit of $1 million for medical care, but less than $50,000 for lifetime mental health and addiction treatment.
Many insurance agencies only provide coverage to individuals who are suicidal, homicidal, or unable to function. At Rogers, these individuals are admitted for inpatient care. Once the patient is temporarily stabilized, coverage ends. The patient’s critical needs are met, but treatment to sustain a healthy and productive life falls short.

Rogers responds

Utilization review

To combat this issue, Rogers Behavioral Health created a Utilization Review Department. This department evaluates a patient’s medical needs at the time insurance denies coverage for treatment.

They determine when it is appropriate to go back to the insurance company to make the case for coverage. They have reported that the inpatient denial rate for coverage is 3%, partial hospitalization denial rate is 10% and residential denial rate is 25%. The department conducts 20,000 reviews each year.

Because of the rate of denial, Rogers has also hired financial counselors to work with families to help navigate the insurance process and to create payment plans when needed in order to ensure admission to, or completion of, the treatment process. Families know ahead of time that if or when insurance ends, a backup plan is already in place.

Patient Care Grants

Rogers Foundation provides Patient Care Grants to families who have reached their limit for insurance coverage, as well as for those whose personal resources are depleted. These grants give patients the opportunity to continue treatment to the point of full recovery.

During fiscal year 2021, the Foundation distributed $1.5 million in patient care grants, amounting to 2,150 days of treatment for those in need.

Learn more about mental health and addiction challenges and the work of Rogers Behavioral Health Foundation on our YouTube channel.