Last Week Tonight - MeNtal Health Care

[nakedfrog]

Not mental health related, but my kid just went in to their GP for a checkup etc and he suggested they have some tests run, so we did.
The insurance refused to cover one of the tests sighting it "medically unnecessary" (akin to what was said in the Last Week Tonight clip). So if a doctor prescribes XYZ, the insurance company can overrule the doctor AFTER the fact and just leave you holding the full bill? That is INSANE.

On a similar note, a few years back, my son needed spinal fusion surgery. It was required by his doctor,. a back specialist and the surgeon . We happened to get an opening in the surgeon's schedule so everything was a little "rushed". The day before the surgery, insurance called up and had a million questions, and were refusing to cover until things could be discussed etc (we're talking a $300,000+ surgery) There was no time for further discussion etc, surgery was 7am the next morning. But they left us hanging.

We explained it all to the surgeon (whom we loved, and know many people who have had him and speak nothing but praise) and he was like "they do this EVERY time, it's easy to fix, but they do it every time... We'll just prep your son, get him wheeled into surgery and before I scrub up I will call them and explain that we're little in the room etc and they will cave and approve it."

and sure as shit that's what happened - exactly as he laid it out. It's disgusting that that's how it has to happen. AND apparently, happen often.

Sorry, I got off the Mental Health Care topic, but it's all related.

Yeah, I have a procedure I go in for regularly that's explicitly covered in my insurance documents, and has been paid out month after month. But first it has to be submitted, then get automatically denied, then have someone else (working within the SAME insurance company, mind you) resubmit it, and then they pay out. It's stupid and I hate it.

 

[interchange]

Not mental health related, but my kid just went in to their GP for a checkup etc and he suggested they have some tests run, so we did.
The insurance refused to cover one of the tests sighting it "medically unnecessary" (akin to what was said in the Last Week Tonight clip). So if a doctor prescribes XYZ, the insurance company can overrule the doctor AFTER the fact and just leave you holding the full bill? That is INSANE.

On a similar note, a few years back, my son needed spinal fusion surgery. It was required by his doctor,. a back specialist and the surgeon . We happened to get an opening in the surgeon's schedule so everything was a little "rushed". The day before the surgery, insurance called up and had a million questions, and were refusing to cover until things could be discussed etc (we're talking a $300,000+ surgery) There was no time for further discussion etc, surgery was 7am the next morning. But they left us hanging.

We explained it all to the surgeon (whom we loved, and know many people who have had him and speak nothing but praise) and he was like "they do this EVERY time, it's easy to fix, but they do it every time... We'll just prep your son, get him wheeled into surgery and before I scrub up I will call them and explain that we're little in the room etc and they will cave and approve it."

and sure as shit that's what happened - exactly as he laid it out. It's disgusting that that's how it has to happen. AND apparently, happen often.

Sorry, I got off the Mental Health Care topic, but it's all related.

I know of it happening for a patient for one of our other docs where the insurance had already authorized continued hospitalization, and after the patient was discharged reviewed the case again and reversed their decision to cover some of their hospital stay. For all I know that has happened to many others, but since the patients have already left the hospital I don't usually hear about this stuff. I have run into times where the insurance won't schedule a review for coverage until several days after they have agreed to cover, leaving you in a position of choosing whether to keep a person in the hospital without knowing if their insurance will pay for it. Thankfully I'm in academics where the pressures to always have everything covered are somewhat less (though by no means absolved).

Yeah I work with Medicare frequently for work. They are some of the worst when it comes to documentation and weird ass requirements.

Moving to single payor will be a shit show if it operates under that same model. There's major revisions required there before expanding it further.

For psychiatric inpatient coverage at least, Medicare is the easiest to deal with. They leave us to apply the InterQual criteria ourselves.

 

[brycejones]

Yeah, I have a procedure I go in for regularly that's explicitly covered in my insurance documents, and has been paid out month after month. But first it has to be submitted, then get automatically denied, then have someone else (working within the SAME insurance company, mind you) resubmit it, and then they pay out. It's stupid and I hate it.

My family had to fight this shit all the time while my sister was a child as a type 1 diabetic. The number of times they denied paying for insulin was just mind boggling.

 

[vi edit]

For psychiatric inpatient coverage at least, Medicare is the easiest to deal with. They leave us to apply the InterQual criteria ourselves.

I deal with it in an IT capacity. I'm on 2 projects right now I've thrown a couple thousand hours of IT resources at only to have CMS yank the mandate. Some times they give you 3 months warning to completely change a billing mechanic and build out a brand new means of data gathering and dashboards. Then 2 weeks before you are supposed to start they hit the panic button and put a hold on it. Reschedule for another year, then do the same thing. Just waiting for congress to figure out WTF to do. Ultimate congress votes on whether to move forward with something for a lot of these.

We have entire compliance departments dedicated to lobbying for CMS policy and interpreting it.

Healthcare should not be something that's at the whim of political winds, what administration is in place, and what party is in power. It needs to be spun off to something..else.

 

[nickqt]

Mental health care is absolutely amazing as long as you have the correct position at a company that has money, or you have the money to pay for it youself.

In the United States, this is a feature and not a bug.

This also extends to all healthcare, whether it's a sprained ankle or cancer.

Everything is a commodity by design, and the answer is having money to purchase that commodity. Anything less would be anti-American, and frankly, communist. Don't believe me, ask 47% of your fellow Americans and 55% of all elected officials who write the rules commodifying everything.

 

[hal2kilo]

You mean we're supposed to be happy and well adjusted. Damn, I've been doing it all wrong.

 

[pmv]

HA! Edited

Interesting that if I google for "metal health care" I get a lot of hits from serious websites with the same typo

Some charity promoting physical exercise:

Moving for Metal Health Report Launched | Active Partnerships

www.activepartnerships.org

Some humanitarian aid organisation discussion:

And even the UK Police Federation:

#MentalHealthAwarenessWeek: We want to see improvement in the provision of metal health support for our colleagues

www.polfed.org

The NHS is pretty poor with regard to mental health provision. And with the pandemic what there was seems to have been completely overwhelmed.

 

[Drach]

On my end I've got a teenage daughter that is just a weekly stream of "what new hell can we find this week".

It's just...too much.

Been there done that. I promise you it gets better in the long run. My oldest took until she was 21.
My youngest, well she just got her period. Fingers crossed

 

[cytg111]

Not mental health related, but my kid just went in to their GP for a checkup etc and he suggested they have some tests run, so we did.
The insurance refused to cover one of the tests sighting it "medically unnecessary" (akin to what was said in the Last Week Tonight clip). So if a doctor prescribes XYZ, the insurance company can overrule the doctor AFTER the fact and just leave you holding the full bill? That is INSANE.

On a similar note, a few years back, my son needed spinal fusion surgery. It was required by his doctor,. a back specialist and the surgeon . We happened to get an opening in the surgeon's schedule so everything was a little "rushed". The day before the surgery, insurance called up and had a million questions, and were refusing to cover until things could be discussed etc (we're talking a $300,000+ surgery) There was no time for further discussion etc, surgery was 7am the next morning. But they left us hanging.

We explained it all to the surgeon (whom we loved, and know many people who have had him and speak nothing but praise) and he was like "they do this EVERY time, it's easy to fix, but they do it every time... We'll just prep your son, get him wheeled into surgery and before I scrub up I will call them and explain that we're little in the room etc and they will cave and approve it."

and sure as shit that's what happened - exactly as he laid it out. It's disgusting that that's how it has to happen. AND apparently, happen often.

Sorry, I got off the Mental Health Care topic, but it's all related.

Holy shit. I would have bailed on that state/country whatever in a heartbeat (who knows how long you'll have one). Report the Insurance company to the police, feds, all of them.
Wonder what said insurance company profits look like? Healthcare for profit... who could possibly predict that would go to shits... specially without proper regulation.
(and remember to record all conversations so you have a trail for when this shit happens).

 

[TheVrolok]

I saw it. Pretty well done overall. That insurance reviewer gave me the cringes. Most are not like that, but I've run into it. Once, very explicitly (although we were able to get coverage) where the insurance's answer to why they were not providing coverage was basically them saying "we think you're lying".

It's sad, playing Devil's Advocate (which is just dirty feeling when talking about the insurance industry) there's a fair bit of pressure to lie, too. It's largely incentivised by other parts of the system. It's so incredibly frustrating how it's later of broken system on top of layer of broken system.

 

[TheVrolok]

Yeah I work with Medicare frequently for work. They are some of the worst when it comes to documentation and weird ass requirements.

Moving to single payor will be a shit show if it operates under that same model. There's major revisions required there before expanding it further.

On our side, working with Medicare in most cases is dramatically better than working with shitty commercial products.

 

[Captante]

Mental health care is absolutely amazing as long as you have the correct position at a company that has money, or you have the money to pay for it youself.

In the United States, this is a feature and not a bug.

This also extends to all healthcare, whether it's a sprained ankle or cancer.

Everything is a commodity by design, and the answer is having money to purchase that commodity. Anything less would be anti-American, and frankly, communist. Don't believe me, ask 47% of your fellow Americans and 55% of all elected officials who write the rules commodifying everything.

Or to be capable of arranging to cost said insurance company 1000x more money by suing and making a bunch of public noise if they deny coverage.

IME it's amazing how quickly a credible threat of expensive litigation gets a response from insurance companies when nothing else will.

Profit is the ONLY thing these "people" care about and threatening that profit is the only leverage individuals have in 'murica when it comes to healthcare.

 

[nakedfrog]

Been there done that. I promise you it gets better in the long run. My oldest took until she was 21.
My youngest, well she just got her period. Fingers crossed

I had a similar situation with my son, I'd mentally prepared myself for him to not survive to 18, and after he moved out, he spent a big chunk of the year homeless, living out of his car, but has now finished his first year of college, which he got into by himself. Was a hell of a ride for a few years, and in another two years, I'll be done paying for the mental health care he received...

 

[blackangst1]

Watched his segment last night and it just hit home hard. Our country is on a death march towards a cliff of anxiety, depression and suicide.

This. Mental health is STILL taboo in this country, and care is abysmal.

 

[Fenixgoon]

I had a similar situation with my son, I'd mentally prepared myself for him to not survive to 18, and after he moved out, he spent a big chunk of the year homeless, living out of his car, but has now finished his first year of college, which he got into by himself. Was a hell of a ride for a few years, and in another two years, I'll be done paying for the mental health care he received...

I'm sorry your son has had such a tumultuous journey but it sounds like he's on a great path now! Kudos to you both

 

[nakedfrog]

I'm sorry your son has had such a tumultuous journey but it sounds like he's on a great path now! Kudos to you both

Thanks Without going too much into backstory, my ex/his mom died from "multidrug toxicity" when he was 11 and had not been the greatest parent in the world to put it lightly, so he didn't exactly have an easy time in front of him.

 

[[DHT]Osiris]

On our side, working with Medicare in most cases is dramatically better than working with shitty commercial products.

Same for the customer side, as long as they cover whatever you need covered (and until you need to prove you still qualify).

 

[hal2kilo]

I had a similar situation with my son, I'd mentally prepared myself for him to not survive to 18, and after he moved out, he spent a big chunk of the year homeless, living out of his car, but has now finished his first year of college, which he got into by himself. Was a hell of a ride for a few years, and in another two years, I'll be done paying for the mental health care he received...

Well since we are all confessing, my 38 yr old son, will probably be moving in with me after my ex is moved up to where my daughter lives in Minnesota due to her losing her shit due to the onset of Alzheimer's. My son hasn't had a job for more than maybe 2 years at a stretch. It's weird when you wish it was drugs. Lost Genxr.

 

[nakedfrog]

Well since we are all confessing, my 38 yr old son, will probably be moving in with me after my ex is moved up to where my daughter lives in Minnesota due to her losing her shit due to the onset of Alzheimer's. My son hasn't had a job for more than maybe 2 years at a stretch. It's weird when you wish it was drugs. Lost Genxr.

I sure hope my kids never have to move back in with me, but it's not like I'm gonna say no. My condolences.

I suppose I could say I did specifically tell my kid he could come home whenever, but he's very stubborn and wanted to do things his way (gosh, can't imagine where he'd have picked up that kind of attitude)

 

[Captante]

Well since we are all confessing, my 38 yr old son, will probably be moving in with me after my ex is moved up to where my daughter lives in Minnesota due to her losing her shit due to the onset of Alzheimer's. My son hasn't had a job for more than maybe 2 years at a stretch. It's weird when you wish it was drugs. Lost Genxr.

Sorry to hear that.... you're a good guy helping him out.

And don't feel too bad.... while both my daughters are healthy and doing well in their personal lives, neither one is speaking to me at the moment over some BS with my ex-wife.

Life is just chock-full of stomach-churning drama isn't it?

 

[hal2kilo]

Sorry to hear that.... you're a good guy helping him out.

And don't feel too bad.... while both my daughters are healthy and doing well in their personal lives, neither one is speaking to me at the moment over some BS with my ex-wife.

Life is just chock-full of stomach-churning drama isn't it?

Well, the only good thing that has come out of this so far, is that my daughter is talking to me again. Again also over BS.

 

[DaaQ]

Mental health care is absolutely amazing as long as you have the correct position at a company that has money, or you have the money to pay for it youself.

In the United States, this is a feature and not a bug.

This also extends to all healthcare, whether it's a sprained ankle or cancer.

Everything is a commodity by design, and the answer is having money to purchase that commodity. Anything less would be anti-American, and frankly, communist. Don't believe me, ask 47% of your fellow Americans and 55% of all elected officials who write the rules commodifying everything.

Just want to point out, IMO, this percentage is way too high.
Elected Officials, hardly ever write the actual legislation they are elected to write. They "sponsor" a bill, drawn up and handed to them by whatever Lobbyist is trying to pass legislation "In their best interest"

This. Mental health is STILL taboo in this country, and care is abysmal.

Thank Reagan.

 

[Captante]

Well, the only good thing that has come out of this so far, is that my daughter is talking to me again. Again also over BS.

Don't knock it!

 

[Homerboy]

Well since we are all confessing, my 38 yr old son, will probably be moving in with me after my ex is moved up to where my daughter lives in Minnesota due to her losing her shit due to the onset of Alzheimer's. My son hasn't had a job for more than maybe 2 years at a stretch. It's weird when you wish it was drugs. Lost Genxr.

There's no "confessing" - that makes it sound like there's something to be guilty/embarrassed about. Life is HARD. Like REALLY HARD. And not everyone can make it through with major trouble.

Our youngest child has been struggling with sever depression,. anxiety, gender identification... the list is long... for years now. They're 19 and haven't graduated HS (barely gone to school since middle school). They are struggling every day with virtually everything. It's no picnic for anyone - especially my wife who has carried the weight of the burden and now has her own troubles. And in turn we have our own troubles together. Not me though... I'm SURE that I'm perfect.

EVERYONE has skeletons they hide. There's just no way around it. And this world, and certainly our mental healthcare system does not do what is needed to help people. That's why I made the post. That's why the John Oliver segment kicked me in the crotch.

 

[Jaskalas]

@Homerboy What is Metal health care? Is it something for my car?

HA! Edited

Given the absolute lack of mental healthcare, I might think the typo is more correct than it is wrong.

When considering the topic, I have vague ideas of what the the profession(s) are. But I have no real idea of what it is actually for, or what circumstances I would consider myself in need of it. Nor what positive results I could envision from it.

If I am physically injured or sick... I understand what a doctor and a hospital is for. And the outcome I would like.
Cannot say the same for mental health. Cannot say I even understand what it would be used for. Or when to know when there is a need.

Perhaps that is also how insurance treats it. As some frivolous optional vagary of undefined or... optional value. A needless expense that does nothing.

We could start by addressing such notions. If they are wrong, they should be declared wrong. The very ideas campaigned against. A proper frame of reference for mental health should be part of education and public awareness. If mental healthcare is a real service, our current system of neglect is likely a result of this information deficit.