The news magazine 60 Minutes said on a recent show that insurers are denying mental health claims for patients in need of chronic long-term mental healthcare. In fact, the show said Anthem had more than a 90 percent denial rate for mental health claims, according to CBS News.
The 60 Minutes episode talked about patients whose claims were denied; these patients later died or committed suicide. CBS reporter Scott Pelley also implied that insurers' claims denials potentially impact national tragedies like the Sandy Hook Elementary shooting in Newtown, Connecticut.
In response to the episode, Anthem vice president for communications Kristin Binns told Forbes in a statement that it "receives hundreds of thousands of requests for behavioral health treatment each year and the vast majority of these requests are authorized, based on the patient's need and our clinical guidelines."
"More than 90 percent of care requested by members or doctors is approved as requested, and some level of care is usually approved, according to medical and clinical need," she added.
America's Health Insurance Plans CEO Karen Ignagni told Forbes that insurers have a right to appeal their claim denials. "Despite the suggestion by this report, the reality is patients seeking care are afforded access," Ignagni said in a statement to the magazine. "Suggesting that coverage decisions drive the mental health challenges we face in this country does a disservice to the ongoing efforts--involving all stakeholders--to improve the country's health system for those who need behavioral health care."
Although the patients highlighted in the 60 Minutes report had employer-sponsored health plans, the show didn't disclose what specific type of insurance coverage the patients had. In addition, since insurers often simply administer the benefits that the employers want, they don't always have the option to change their coverage.
The Affordable Care Act prevents insurers from denying coverage to patients with pre-existing mental health issues. The ACA also lifts limits on certain types of care for mental health. However, consumers haven't been taking advantage of expanded mental health and substance abuse benefits, FierceHealthPayer previously reported--though that's the result of inadequate resources and low reimbursements as opposed to a lack of coverage.