When insurance companies deny treatment for the mentally ill, it can be devastating to patients and difficult for doctors to prescribe treatment. It can also be tragic. CBS 60 Minutes ran a segment in early December that looked precisely at the role that insurance carriers play in the treatment of patients.
Scott Pelley, who did the interview for 60 Minutes, interviewed the mother of 14-year-old Katherine West, who had bulimia that was supposedly rooted in deep depression. Her mother, Nancy West, had said that her daughter had also been a “cutter.” West’s daughter was recommended for a twelve-week hospital program that would cost nearly $50,000. Against the recommendations of her doctor, the insurance company pushed for Katherine West to be released after only six weeks. She came home as an outpatient. She died shortly after arriving home.
“Did it make sense to you that a doctor at the insurance company was making these decisions based on telephone conversations?” Pelley asked in the interview.
“No. No, they didn’t observe my daughter. You’re talking about a psychiatrist, a pediatrician, a therapist who observed my daughter on a daily basis. But some nameless, faceless doctor is making this decision. And I was furious. Because to me he was playing God with my daughter’s life,” said Nancy West to Pelley.
What is frustrating about the Katherine West story is that an insurance company doctor who had never seen her was making the decision on the best course of treatment. As a practicing psychiatrist, I know that insurance companies are dictating hospital admission and discharge. It has become more difficult for me to get people admitted under the policies defined by the insurance companies — policies that lend themselves more and more towards non-hospitalization. When I do get a patient admitted I also find that insurance carriers are shortening the length of stay, just like in the case of Katherine West.
What is at issue here is the overall health and welfare of the patient. I find the decrease in admission to be a folly since patients are often discharged before even the effectiveness of the prescribed medication can even have an effect. These patients are not even in the hospital long enough for deep exploration of the psychological/social circumstances that brought them there in the first place.
Worse, when they are discharged early and without a full course of treatment they are most often sent back to the stressful environment that precipitated the need for admission. Discharging too early makes it difficult for them to recover and can lead to relapse. Discharging a patient too soon also leads to a “revolving door” syndrome of hospital care with quick re-admissions. When a patient is being discharged, the hospital has to make an appointment with an outpatient facility or program in order for the patient to be discharged. In many cases, an outpatient appointment is scheduled even before the hospital and treating psychiatrist have even been able to prepare a status report. In many cases, it is also before remission of the symptoms that led to the admission in the first place.
The solution lies in more collaboration between the insurance carriers and the doctors who are treating the patients. We are talking about peoples’ lives not just statistics. We are talking about loss of life too. Just read some of the news headlines, and you will often find that a tragic psychiatric mistake was made all too often because of an early discharge or the refusal to allow someone to be admitted in the first place.
Click here to watch Scott Pelley’s 60 Minutes interview “Denied”.
DISCLAIMER
Information contained in this blog is intended for educational purposes only. It is not intended as medical or psychiatric advice for individual conditions or treatment and does not substitute for a medical or psychiatric examination. A psychiatrist must make a determination about any treatment or prescription. Dr. Paul does not assume any responsibility or risk for the use of any information contained within this blog.
