Think you are unfairly being denied mental healthcare for postpartum depression or related illnesses by your insurance company? When and how should you appeal a denial of coverage for mental health services? The National Council for Community Behavioral Healthcare has released a toolkit to help you understand your rights under the Wellstone-Domenici Parity law. The toolkit " … provides tips and helpful resources for filing an appeal when you suspect your plan has unfairly denied behavioral health benefits. Whether an insurance plan has denied coverage for a mental health treatment, required disproportionately high co-pays for addictions services, or imposed other limitations on behavioral health, the Parity Toolkit can help you learn whether your plan may be violating the parity law and how you can appeal its decisions."
Mental Health Care for PPD Denied or Limited By Insurance Co.? Tips on How to Appeal
Can You Or Your Husband Access FMLA If Needed For Postpartum Depression?
Many of you have asked about the Family Medical Leave Act and how that applies to women with perinatal mood and anxiety disorders like PPD, as well as their family members (like husbands). I reached out to 9to5, a national organization dedicated to putting working women's issues on the public agenda. Cindia Cameron, who coordinates 9to5's Job Survival Helpline, was kind enough to give us an outline:
Amother with a diagnosed perinatal mood or anxiety disorder like PPD will have access to the legal protections of the federal Family and Medical Leave Act if she meets each of these eligibility standards:
1. She has worked for her current employer for at least one year.
2. Her employer has at least 50 employees within a 75 mile radius of her workplace
3. She worked at least 1250 hours in the previous year (approx. 24 hr/s week).If she does not meet these criteria, she may have FMLA protections under state law, depending on where she lives. (Several states have FMLA laws that apply to employers of 25 or more, for example). There is also the possibility that she may have the protection of a union contract for FMLA leave.
If she meets these criteria, she has access to 12 weeks of leave in any 12 month period. The 12 weeks can be used for any combination of reasons: childbirth, her own illness, that of the child or any other immediate family member. However she chooses to use the leave, the law provides a total of 12 weeks.
What this means is that if she chose to use 8 weeks leave after the child was born, andthen realized that she was suffering from postpartum depression, she would have only 4 weeks left. After 12 weeks, the protections of the federal FMLA end.
At 9to5 we stress that the law provides the minimum. Companies are certainly free to offer more time off (usually unpaid, but there might be access to long-term disability). Even companies that are not required by law to offer FMLA leave often do.
About the father/husband: If he qualifies under the same eligibility standards, he is eligible both for paternity leave (time to bond with the baby after birth) and time to care for the baby or his wife, if he can provide medical certification from a doctor that one or the other needs care due to their illness. He would also have access to a total of 12 weeks in any 12 month period.
Thank you Cindia! Do any of you have further questions about FMLA for her?
Also, click here for more information on PPD and health insurance.
Do Women Who've Had Postpartum Depression Have To Lie to Get Life Insurance?
Not so long ago, I heard from a mother and advocate I know who had just found out she was being denied life insurance coverage because she had been treated for postpartum depression in the last five years. She was told their policystated that she must wait until five years after the experience with PPD was over(it had already been 4 years!), and could then re-apply for life insurance.
What?!! Who came up with that arbitrary bullshit?! You can imagine my shock and dismay. I had never heard of such a thing. But then I reached out to severalprofessionals I respected to ask if they had seen this happen to their patients, and was disappointed to discover that they had. Here were some of their responses:
"This practice applies for survivors of breast cancer as well — even if you have been 'cured' for over a decade! Discrimination against women's issues for sure! Men who have had life-threatening conditions can get [life insurance] but they have to pay more. With women there are also plans that will offer minimal coverage but are still astronomically expensive."
"Sadly, it is legal and commonplace for life insurance companies to deny coverage based upon a wide range of mental health conditions, including postpartum depression … The life insurance companies justify this based upon their actuarial tables that show people diagnosed with certain mental health diagnoses have shorter life spans. Not sure how significant it is across the board, but apparently significant enough for them to deny taking people's money for policies."
"I have heard of people being denied because of a history of depression. It makes no sense, since most policies don't cover suicide anyway. Interestingly, now we know about connections of depression to other chronic illnesses and heart disease. But since approximately 20% of women get perinatal mood and anxiety disorders, this really wipes out a lot of women. It's discrimination, especially since the prognosis is so good."
My first piece of advice for those of you seeking life insurance who have been treated for a perinatal moodor anxiety disorder like postpartum depression isto try shoppingaround. Difference insurance companies have different underwriting policies and you may find one that is willing to insure you, or that perhaps has a shorter waiting period than 5 years.
If that doesn't work, the website Insure.comsuggestsworking with "… brokers who specialize in finding life insurance for applicants with medical conditions and other red flags. These 'impaired-risk specialists' know which insurers are likely to approve applications for folks with a variety of 'insurability' problems, such as smokers, the overweight and those with a cardiac history."
If that doesn't work, there isanother last-ditch option: You could lie.
I know I'm gonna get it for this one.
At first I wasn't going to write about this option. I teach my children not to lie. I avoid lying, unless it's about somebody's new haircut that I think is not so hot. I don't think lying is a good thing. But what else is a mother to do who is trying to pay for life insurance that will help her family continue on should something happen to her?
While I was equivocating, I happened to read thisreponse in the New York Times' Magazine by Randy Cohen, the paper's ethicist, to a letter from a mother whose son had been denied health insurance after answering truthfully that he had smoked pot in the past. This is what he wrote:
"In this situation, there is no good advice. Some problems are simply not amenable to an honorable individualist solution, offering a choice only between disheartening alternatives.
Honesty may not always be the best policy — and, by the way, do these pants make me look fat? — but we rely on the trustworthiness of those we do business with. Were your son to lie on that form, he'd do his small part to erode that trust. And yet it's hard to see how he'd harm the insurance company. Few dire health consequences result from sporadic youthful pot-smoking or even occasional adult pot-smoking. It is impertinent of the insurer to act on information that is medically insignificant.
And so, were I filling out that form, I'd lie without remorse. (All right, with some remorse. Accompanied by resentment. I blame my upbringing. And my inept, albeit imaginary, therapist.) …"
Cohen's words made me feel slightly more emboldened to share the last-ditch option. I realize, of course,that he was not writing about life insurance, or postpartum depression or people who are taking prescribed antidepressant medication. I imagine he didn't foresee me using his words here. I imagine he would say, as he did in his column, that it would be better to write letters to the life insurance company and appeal the denial. (Remember those professionals Iquoted earlier? They said those appeals often also get denied.) I imagine he'd say you also should write your elected officials and work to get policies like these changed. And I would agree that this is something we all should do.
ButI also believe that, ifyou have had a temporary illness like postpartum depression or anxiety and were treated and have fully recovered and it hasn't impacted your long-term health, it's unfair for you to be denied life insurance. And what does five years have to do with it? If your doctor says youare better and completely healthy, why should you be flat-out denied while the next person is accepted? Any of us could get hit by a bus tomorrow, after all. (Fingers crossed the bus thingdoesn't happen to one of you, or I'm gonna feel really bad about writing that.) I realize you may have to pay higher premiums, but at least then you'd have the opportunity to have the insurance.
You didn't hear this from me, buthere's a tip someone gave me:
If you are applying for life insurance for the first time after having been treated for PPD,you could say youhad been takingantidepressant medication for PMS or perimenopause symptoms.
My sources tell methis has worked for some.If you want to take the risk, you could try it. One side note:If you have already applied for life insurance and been denied, you have to note that denial on future applications with other insurance companies, so this probably wouldn't work. Insurance companies can access medical data about you from other insurance companies via a clearinghouse called the MIB, and would find out you had PPD. As reported by iVillage in an article called "Getting Past Life Insurance Denial", " … if the new application asks you if you have been turned down for insurance in the past, you must answer truthfully. Failure to do so is a misrepresentation and could result in null and void coverage in the future. Through the use of the MIB, the new company may be aware of previously discovered medical indicators or adverse determinations and know that your application is not completely accurate."
I don't want you to have to lie. I want you to be able to have life insurance, should you need it. And I want people — everyday people, insurance company people, political people –to understand that postpartum depression is a temporary and fully treatable illness.
Also, click here for more stories on PPD and insurance.
How DSM-V Language on Postpartum Depression May Affect Insurance Coverage & Research Funding
Here's another expert weighing in onthe new language about postpartum depression in the DSM-V: Susan Stone, LCSW. Susan ischair of the President's Advisory Council of Postpartum Support International.
It takes years (generally) for clinical observation to find representation in the DSM. The basis for making such change requires compelling research, clinical oversight and the agreement of multiple committee members, each with his own perspective and experience. It is a necessarily lengthy and thoughtful process. While the gap between clinical reality and DSM validation may be frustrating at times, the extension of the postpartum onset specifier [to 6 months] is highly significant.
If included, this could help increase access to insurance coverage to mental health services in pregnancy and the postpartum. Liability issues resulting from denial of benefits becomes a more strongly mitigating factor in coverage decisions when the DSM acknowledges and validates the proposed extension. In addition, extending the specifier justifies the research community's ever-widening investigation of perinatal mood disorder incidence and initiation, encouraging funding. These are major gifts which will pave the way for future DSM modifications.
In reading through the language [of Dr. Ian Jones], I did not feel that the writer was denying the existence of pregnancy-related disorders, butcalling for further research. Because the incidence of depression among women is close to the statistics for antenatal and postpartum depression, specific determination of the biopsychosocial characteristics unique to perinatal mood disturbances is needed to justify its entry as a separate group of disorders. Research focused on these determinations will help inform prevention and treatment!
Great insight Susan! Thanks!
How To Appeal Health Insurance Claim Denials
The ever-helpful Patient Money columnist at the New York Times wrote this piece last week on appealing denials of your health insurance claims. Given how little mental health treatment is offered and how difficult it is to get, I figured you'd be more than a littleinterested in these tips!
Click here for more information about the topic of health insurance and PPD.
Obama Sets New Rules for Mental Health Insurance Coverage
The Obama administration weighed in last week on insurance coverage for mental illness and substance abuse treatment. As of July 2010, some new rules will apply, including these:
- Health plans offered at companies with more than 50 employees who already offer mental health benefits must have the same rules for mental health benefits as other benefits. No separate annual deductibles for mental health treatment, and copayments should be the same amount for visiting a psychiatrist or other mental healthcare provider as they are for going your primary care physician.
- Health plans cannot set limits on the number of visits or hospital days for mental health treatment.
For the APA's reaction, click here.
- Employers with less than 50 employees (so that’s virtually all small businesses right there)
- Employers who do not currently offer any mental health or substance abuse benefits
- Individual insurance plans (the law only applies to group insurance plans offered by an employer)
How to Get Help If You Have Postpartum Depression & No Insurance
A few weeks ago I shared with you a story by Lesley Alderman at the New York Times on making the most of your mental health insurance benefits. But what about those of you who have postpartum depression or a related illness and who don't have insurance?What if you have very limited mental health benefits? Alderman has written a follow-up columnen titled "How to Find Mental Health Care When Money Is Tight". She writes:
"According to a recent survey by the federal Substance Abuse and Mental Health Services Administration (Samhsa, pronounced SAM-suh), the leading reason that people with mental health issues don’t seek treatment is cost. They fear the fees."
If you've been reading Postpartum Progress for any length of time, you know that avoiding getting help is not an option when it comes to perinatal mood and anxiety disorders like PPD. Thankfully there are things that you can do that are low-cost or even no-cost.
One of Alderman's suggestions is to join a support group. These are most often free, andpeer supporthas been shown to lessen the symptoms of postpartum depression. You can click here for Postpartum Progress' list of postpartum depression support groups, and here for the list compiled by Postpartum Support International.
Aldermanalso lists free crisis lines like 1-800-273-TALK. Some states offer crisis hotlines specific to postpartum depression. In Illinois, the Jennifer Mudd Houghtaling Foundation has a crisis hotline for people in certain area codes (312, 773, 847, 708, 630, 815) at 1-866-364-MOMS. New Jersey also has a Postpartum Depression Family Healthline at 1-800-328-3838. And Postpartum Support International has a warm-line at 1-800-944-4PPD where you can ask questions during business hours.
I'd like to add a couple of things to Alderman's suggestions. One is to check into clinical trials on PPD. If there is one in your area and you are willing to participate, your care is often free during the period of the trial. You can search for clinical trials on perinatal mood and anxiety disorders here.
Additionally, there arebooks that you may find helpful. One, called the "Pregnancy & Postpartum Anxiety Workbook" by Pamela Weigartz helps you work through feelings of anxiety with the help of easy exercises and worksheets. The book "This Isn't What I Expected: Overcoming Postpartum Depression" by Karen Kleiman also offer sbrief self-help worksheets and exercises.
To read Alderman's entire column and see more of her suggestions, click here.
Also, you can click the link for more stories on PPD and health insurance.
Photo credit: © Amy Walters – Fotolia
How to Make the Most of Your Mental Health Benefits
Many women with postpartum depression who want to reach out for professional help aren't sure iftherapyis even covered by their insurance, and many who do have coverage find it can be quite limited. The New York Times' Patient Money columnist Lesley Alderman has written a much-needed column on how to make the most of your mental health insurance benefits. She offers great tips, especially in light of the fact that the Mental Health ParityLaw is about to take effect in January. You might find thatthe benefits your insurance company offers for mental health care have been improved. Check out her column to learn more.
Note: She says her next column will cover how to get mental health care if you don't have insurance. I will let you know about it when it's published.














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