I recently had a conversation with Joe Feldman, who is the Founder of CoverMyMentalHealth.com and mental health care advocate. While we all know there is supposed “parity” for insurance coverage of mental health and substance use disorders, in practice that is not the case.
In our conversation, Joe brought up an important idea that can forestall the agonizing appeals process for insurance claim denials. That idea is the medical necessity letter. This is significant, because while parity is required by law, insurers often base their denials on lack of medical necessity. If a clinician hasn’t proactively written a letter, the insurer many times just overrules a clinician’s determination of the proper course of treatment even if in the long run that is economically and medically the best cost of action.
I recommend going to Joe’s website for more about the medical necessity letter here, as well as a very detailed journal article (click here). Typically, the letter is going to be written by a psychiatrist for behavioral health issues.
For family members and loved ones struggling financially with the cost of mental health and addiction treatment, Joe Feldman’s work is extremely helpful. Thank you, Joe!