Welcome to my blog, which speaks to parents, professionals who work with children, and policy makers. Through stories from my behavioral pediatrics practice (with details changed to protect privacy) I will show how contemporary research in child development can be applied to support parents in their efforts to facilitate their children’s healthy emotional development. I will address factors that converge to obstruct such support. These include limited access to quality mental health care, influences of a powerful health insurance industry and intensive marketing efforts by the pharmaceutical industry.

Monday, January 25, 2010

Children Abandoned by the Health Insurance Industry

After submitting an op ed about the health insurance industry published in today's Boston Globe
I learned about another story of possible mass abandonment of children by the health insurance industry. As with all of my stories, details have been changed to protect the patient's privacy.

Seven year old James was having frequent stomach aches. A full evaluation showed no medical explanation. His mother, Stephanie, was convinced it was "stress." A one hour visit Stephanie by herself revealed the cause. In a slow calm deliberate manner she told me a story of violence and terror.

Stephanie described multiple arrests of James' father for violence towards her, all witnessed by James. Yet now, two years after the latest event, the parents shared custody. James went between the home of his mother and father every other weekend. None of these traumas had ever been addressed in any way.

I told Stephanie I agreed that the stomach aches were indead a symptom of stress. But it was critical that we address not only the symptom, that is not only "what to do" about the stomach aches, but also the meaning of the symptom. I said that James had likely been traumatized by these events and that he continued to experience significant stress on a psychogical level as he traveled between these two homes. Therapy, where both James and his mother together could come to understand what had happened, was essential. Furthermore, the younger James was when he was given this opportunity, the more likely he would be able to get past it.

Mom agreed, and I gave her names of some excellent colleagues who accept their insurance. Later that afternoon, I called one of these colleagues to make sure that he had time. That was when the horror really began.

He said that he was not taking any new patients with this insurance for the following reason. He had received notification a few weeks earlier that this company was now outsourcing its mental health care to another company. All providers would have to get recredentialed, a long labor intensive process. This new company would lower the fee from $75 for a one hour session to $60. There were tighter restrictions on extending coverage beyond a set number of weeks.

This means that mental health practitioners all over Massachusetts are facing a heartbreaking decision. Doing therapy with children is much more than a 50 minute session. It involves speaking with teachers, talking to divorced parents at separate times on the phone, going to school meetings. None of this time is reimbursed. So being paid $60 per visit is impossible. One cannot earn a living with a practice of kids on this insurance. And effective treatment takes months to years, not weeks. Fighting with the insurance company over coverage for each visit is an untenable situation.

I had to call James' mother and tell her that with her insurance she would have difficulty finding a therapist, and that the people I recommended were not available at this time. She was reluctant to pursue therapy in the first place. The fact that I could not connect her with a person I trusted made her back away in full retreat.

Perhaps the worst part of this story is about all of my other patients who are in treatment with my colleague. If he makes the agonizing choice that he cannot afford to contract with this new insurance company, he will no longer be able to see those children.

Multiply this by hundreds of therapists seeing thousands of kids all over Massachusetts. This decision by the insurance company, with its unlimited power, could lead to abandonment of countless vulnerable children.

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