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Sorry if this should be in the mental health subforum, but I was afraid it would get overlooked there, and I really need advice.
My husband was hospitalized back in mid-April for major depression. It's a long story, but he was actually suicidal briefly when he was admitted, so it was a much needed hospitalization.
Anyway, we got the copy of the claim settlement statement from the insurance company over the weekend and when I called them this morning, I was told that our policy doesn't cover things like bipolar, major depression, etc., only substance abuse. What???? Isn't that discrimination? How can they decide that one disorder is "important" enough to be covered but not another? To make matters even more confusing, they will pay for outpatient counseling as long as there is a diagnosis such as...major depression! I'm so confused. Are they allowed to pick and choose things like this? Also, the statement said nowhere on it that they didn't cover major depression, in fact, it didn't even give a reason why they said they wouldn't pay. Also, in one place, it stated that the patient's responsibility was $16.00 and in another place on the page, that the patient's responsibility was over $9,000.00. Huh???
The lady that I spoke to seemed confused as well, and she had to go speak to a supervisor, so they are reprocessing the claim. In the meantime, I need to know: can they discriminate between things like substance abuse and major depression? Aren't they both considered diseases? Should I call a healthcare attorney? Help!
Sorry if this should be in the mental health subforum, but I was afraid it would get overlooked there, and I really need advice.
My husband was hospitalized back in mid-April for major depression. It's a long story, but he was actually suicidal briefly when he was admitted, so it was a much needed hospitalization.
Anyway, we got the copy of the claim settlement statement from the insurance company over the weekend and when I called them this morning, I was told that our policy doesn't cover things like bipolar, major depression, etc., only substance abuse. What???? Isn't that discrimination? How can they decide that one disorder is "important" enough to be covered but not another? To make matters even more confusing, they will pay for outpatient counseling as long as there is a diagnosis such as...major depression! I'm so confused. Are they allowed to pick and choose things like this? Also, the statement said nowhere on it that they didn't cover major depression, in fact, it didn't even give a reason why they said they wouldn't pay. Also, in one place, it stated that the patient's responsibility was $16.00 and in another place on the page, that the patient's responsibility was over $9,000.00. Huh???
The lady that I spoke to seemed confused as well, and she had to go speak to a supervisor, so they are reprocessing the claim. In the meantime, I need to know: can they discriminate between things like substance abuse and major depression? Aren't they both considered diseases? Should I call a healthcare attorney? Help!
People think that discrimination is illegal...
I have no idea where this come from...
ONLY age, sex, religion and race, nationality and this is only for employment.
Let me give you an example, depending on which state you live, sexual orientation is a legal discrimination...
For example if I have a company (which I do) and I found out that one of my employee is homosexual (which I don't really care if thy are or not), there is no federal law against it, then every state has their own discrimination law, so if my company is in NY, I can't fire him, but since my company is in Florida, and Florida has no laws protection sexual orientation, I can LEGALLY discriminate and fire him if I want to.
Discrimination laws are only for employment and nothing law, the next law is for Rest., theaters, and public services.
that is it,...
Discrimination in this country is 100% legal, look at all the gyms that only allow women, that is discrimination against men, is a sex discrimination but is legal, what about a spa only for women or a doctor office that only accepts people without insurance or younger patients or even white patients, that is still legal.
Now your question should have been, is this legal? that depends on your policy.
Just because you have insurance that doesn't mean that everything is covered especially when it comes to psychology.
Thanks for your replies. The reason why I don't think it's legal, or at the very least is discrimination, is because they will cover counseling as long as the diagnosis is major depression, so how can that diagnosis be okay for one type of service but not another? Also, they cover substance abuse, which is, let's call it what it is, a disease brought on by a voluntary choice to abuse drugs or alcohol, but they don't cover depression, which is an involuntary medical condition caused by a chemical imbalance in the brain that you're born with?
I am going to pursue other avenues if they don't fix this issue. They are going to resubmit the claim, so maybe they realized when I called and brought it to their attention that they screwed up. If not, I will get a healthcare attorney involved.
Thanks for your replies. The reason why I don't think it's legal, or at the very least is discrimination, is because they will cover counseling as long as the diagnosis is major depression, so how can that diagnosis be okay for one type of service but not another? Also, they cover substance abuse, which is, let's call it what it is, a disease brought on by a voluntary choice to abuse drugs or alcohol, but they don't cover depression, which is an involuntary medical condition caused by a chemical imbalance in the brain that you're born with?
I am going to pursue other avenues if they don't fix this issue. They are going to resubmit the claim, so maybe they realized when I called and brought it to their attention that they screwed up. If not, I will get a healthcare attorney involved.
Thanks again.
Because discrimination is legal.
And you have to read your policy... If your policy say that they wont cover depression, then you are out of luck.
This is not difficult to understand, if you have health insurance and not dental, then you have an emergency and go to a dental office for services, would you be saying how come my health insurance doesnt cover dental services?
Same for surgery, for example, if you are 100 pounds overweight your insurance might cover bariatric surgery, others company might not, it might be 150 pounds, or it might not even cover it even if you are 500 over.
So where is the discrimination, well if you weight 80 pounds you dont get it, it is all about your policy...
Health insurance is not a right, if you are paying for insurance that covers it and they deny the services then they are breaking a contract, if you are paying for a health insurance that doesnt cover, then you are out of luck.
Is completely legal, what they are doing as long as is part of policy.
Thanks for your replies. The reason why I don't think it's legal, or at the very least is discrimination, is because they will cover counseling as long as the diagnosis is major depression, so how can that diagnosis be okay for one type of service but not another? Also, they cover substance abuse, which is, let's call it what it is, a disease brought on by a voluntary choice to abuse drugs or alcohol, but they don't cover depression, which is an involuntary medical condition caused by a chemical imbalance in the brain that you're born with?
I am going to pursue other avenues if they don't fix this issue. They are going to resubmit the claim, so maybe they realized when I called and brought it to their attention that they screwed up. If not, I will get a healthcare attorney involved.
Thanks again.
I'm sorry to tell you this but they are perfectly within their rights to cover whatever they want in any manner they want as long as its disclosed in the policy when it is bound or during the renewal period. I can almost guarantee you that it is disclosed somewhere in the fine print. Going to an attorney will only cost you money with no benefit. I suggest that you get your hands on the policy (including all exclusions and disclaimers) to see exactly what is and is not covered under your current coverage. You will also be in a better position in arguing with them for coverage if you can discuss the details of the policy with them intelligently. Good luck & I hope your husband is feeling better.
People think that discrimination is illegal...
I have no idea where this come from...
ONLY age, sex, religion and race, nationality and this is only for employment.
Let me give you an example, depending on which state you live, sexual orientation is a legal discrimination...
For example if I have a company (which I do) and I found out that one of my employee is homosexual (which I don't really care if thy are or not), there is no federal law against it, then every state has their own discrimination law, so if my company is in NY, I can't fire him, but since my company is in Florida, and Florida has no laws protection sexual orientation, I can LEGALLY discriminate and fire him if I want to.
Discrimination laws are only for employment and nothing law, the next law is for Rest., theaters, and public services.
that is it,...
Discrimination in this country is 100% legal, look at all the gyms that only allow women, that is discrimination against men, is a sex discrimination but is legal, what about a spa only for women or a doctor office that only accepts people without insurance or younger patients or even white patients, that is still legal.
Now your question should have been, is this legal? that depends on your policy.
Just because you have insurance that doesn't mean that everything is covered especially when it comes to psychology.
Read your policy. If you can't understand the terminology take it to an attorney. They will cover anything that is specified in the policy and not cover anything they did not specify. There is usually a great deal that is not covered. It's up to you to determine if that is the coverage you want, when you buy the policy. No one can make an insurance policy pay for something that is not covered.
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