The Legal Implications of Mental Health Coverage Denials

Unfortunately, awareness of mental health needs is still fairly low on a global scale. Even in developed countries like the United States, access to mental healthcare is surprisingly low. 

With the general cost of healthcare in the U.S. being so high, access to mental healthcare often depends on the policies and practices of insurance companies. Few people can afford the necessary treatment without an insurance plan. 

Naturally, insurance companies are primarily profit-driven businesses, so they often look for ways to deny insurance claims whenever possible. In the case of mental health coverage, denied claims can have a detrimental effect on the patient, as well as on the patient’s family and other loved ones. 

With that in mind, let’s explore the legal implications of mental health coverage denials — and what you can do about them. 

What Can I Do If My Claim Is Denied?

In many cases, your health insurance provider may deny your coverage claim. While the situation may seem desperate, take a breather — you can still take legal recourses. 

Depending on your specific circumstances, you may be able to file an appeal and try to have their decision overturned. However, be prepared for a tough battle. Insurance companies usually have solid legal teams, and you must be certain you have a leg to stand on first. 

Luckily, some insurance providers have a long history of providing quality mental health coverage. That’s why mental health centers often work with major insurers like Blue Cross Blue Shield coverage, ensuring that individuals can access the care they need while navigating the complexities of insurance claims and legal disputes.

If you’re going to dispute an insurer’s decision legally, it’s always a good idea to hire an experienced attorney. Preferably, look for someone with experience in this field — a lawyer who has previously dealt with denied mental health coverage claims. 

Why Has Your Coverage Been Denied?

There are many reasons why an insurance company might refuse your mental health claim. 

That’s why it’s important to choose your insurance provider carefully — and not always believe their marketing. Many less-than-reputable insurance companies might only claim they provide coverage for mental health patients. In reality, the companies will use every legal method to deny your claim — and they’re surprisingly creative at this “game.” 

While entering an insurance dispute, insurance companies usually cite one of the following reasons:

• Missed submission timeframes
• Wrong billing codes
• Provided services exceed coverage
• Missing documentation
• Incorrect patient information
• No preauthorization

Remember that these aren’t the only reasons for mental health coverage denials. In practice, they’re just the most common ones. If the reason your claim was refused is not on this list, we suggest checking out your insurance company’s documentation. In most cases, you can find more details in their policy docs. 

Hiring a health insurance attorney might also be the right course of action. And that’s especially true if you don’t want to deal with the appeal process yourself. 

What Can You Do?

Unfortunately, there’s quite a stigma against mental health — even in the United States and the rest of the developed world. Minimizing the need for mental health coverage helps most insurance companies who primarily chase the bottom line. 

In reality, mental health treatments are just as necessary as surgery or insulin. But health insurers don’t always have the same view. More often than not, they’re quick to discredit mental health treatments as not “medically necessary.” In some cases, like severe depression, this can be particularly devastating for patients who cannot pay for treatments out of pocket.

So, what can you do if your claim is denied? 

Your next best step is filing an appeal. You may not always have the grounds for one, but nothing stops you from filing it. Of course, your chances of success are increased if you have qualified guidance from legal professionals. That also makes receiving compensation a more likely outcome. 

What To Do Immediately After Receiving Mental Health Coverage Denials

With all this in mind, what should you do immediately after reading the denial letter?

For starters, you should:

1. Thoroughly inspect the denial letter. Maybe you can already surmise why your insurance provider denied your claim and whether you can do anything about it. 
2. Examine your health insurance policy to see if mental health services are covered. 
3. Read about the appeal submission process in the policy. 
4. Discuss the denial with your healthcare provider. Ask them for a formal letter that shows your mental health treatment was medically necessary. 
5. Include all relevant information in the appeal letter. That includes:
   1. Name
   2. Contact information
   3. Policy number
   4. Date when you received the healthcare service
6. Check with a legal professional before submitting the letter. 

They could also manage this process if you can afford an attorney. An attorney with experience in denied claims can easily review your situation and draft an effective appeal letter. Ultimately, a lawyer can negotiate on your behalf and pursue other legal courses of action. 

Conclusion

At the end of the day, few healthcare issues are as sensitive as mental health. The amount of bias against mental health patients is still significant, and their struggles are often waived away as less important.

That goes to the benefit of some insurance providers, but in reality, mental health problems are just as worth solving as other healthcare issues. And that makes the legal implications of mental health coverage denials even more difficult. 

In a perfect world, people who rely on insurance companies for coverage and easier payments should always have access to mental health treatment. These days, that’s not always the case. With that in mind, always be ready to file an appeal to a mental health coverage denial. 

You have a right to decent mental health and the treatment you need to achieve it. However, not all insurance companies always have this interest in mind. So, choose your provider carefully and be ready to pursue legal recourse upon denial.