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N.Y.C. Council speaker calls on Mayor Eric Adams to resign; KY could do more to protect kids from accidental drug ingestion, shootings; OH food banks face fed funding uncertainty, DeWine budget cuts; Protesters say Trump administration actions 'cast aside democracy.'

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On a Middle East visit, Sen. Richard Blumenthal rejects a Gaza takeover. President's Day protests erupt around the country against White House moves, and another aviation accident draws attention to recent FAA cuts.

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Rural America struggles with opioids and homelessness in unexpected ways, Colorado's Lariat Ditch could help spur local recreation, and book deliveries revive rural communities hit by Hurricane Helene.

Insurance companies denying coverage for Coloradans' mental health care

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Tuesday, January 21, 2025   

More than 1 million Coloradans are living with a diagnosed mental health condition but insurance companies are denying coverage for care their policies promise to pay for.

Jake Williams, CEO of the advocacy group Healthier Colorado, said insurers reject many claims as not medically necessary, even when a doctor has prescribed the treatment.

"Seventy-five percent of Coloradans with commercial insurance, who have a diagnosed mental health condition, have not received the care that they need over this past year," Williams reported. "There are real consequences to this."

In 2008, Congress passed a law requiring insurers to offer the same access to mental health care as to physical care. But a loophole in the law allows insurers to determine what care is "necessary or appropriate."

An investigation by ProPublica found UnitedHealth Group was using algorithms to deny claims, a practice later deemed illegal in three states. United defended its claims program, arguing it ensures patients get safe, effective and affordable treatment.

David Lloyd, chief policy officer for the mental health advocacy organization Inseparable, said insurance companies should not be denying care using standards inconsistent with accepted clinical standards. He believes there are roles for both state and federal lawmakers to address the problem.

"We're encouraging policymakers across the board to take some common sense steps to ensure that health plans are ultimately covering the services that they promised to cover when you have health insurance," Lloyd emphasized.

Williams pointed to a bill recently introduced in the Colorado General Assembly as one path forward. The measure would require insurers to cover treatment using criteria developed by the American Academy of Child and Adolescent Psychiatry, or the American Association for Community Psychiatry.

"What we'd like to do is make it uniform," Williams stressed. "So that just like physical health there's a standard definition of medical necessity, so insurers and patients and doctors are all on the same page, and patients are more likely to get these critical services covered."

Disclosure: Inseparable contributes to our fund for reporting on Criminal Justice, Health Issues, Mental Health, and Social Justice. If you would like to help support news in the public interest, click here.


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