L.I. Business News, March 4, 2016
Access delayed is access denied.
These are words that ring
true for thousands of families across Long Island who have been unsuccessful in
accessing timely and affordable mental health and addictions care through their
health insurer.
How do I know this? From
the stories that people tell us at North Shore Child & Family Guidance
Center, a 63-year-old children’s mental health agency in Nassau County.
Health insurers are
mandated by government to offer panels of providers so that families can find
easily accessible, quality care for their loved ones; and not only for physical
illnesses. This requirement is known as network adequacy, referring to adequate
networks of care.
The problem of access for
mental health care, however, is more complex and may begin with a family’s
hesitance to ask for help and to reveal that they are living with someone who
is suffering from a mental illness. Families coping with mental illness or
addiction do not as readily seek help as they might for heart disease, cancer
or diabetes. Why? Because of stigma and the shame it generates. When there is a
mass shooting for example, and the perpetrator is labeled mentally ill, it
casts a shadow on all people with mental illness, despite the fact that
mentally ill persons are disproportionately the victims of violence.
In the United States we
have chronically failed to treat illnesses above the neck the same as illnesses
below the neck. For example, a parent who would not hesitate to reach out for
help if their child was in an accident and appeared to have broken an arm,
might wait weeks and months, if not longer, to ask for help if it was a mental
health or substance abuse problem.
What makes all this so
insidious is that once a parent picks up the phone to ask for help, and they
are told repeatedly by providers, “I’m sorry I don’t accept that insurance any
longer, I only accept cash,” there is a chance they will give up.
When a parent gives up,
they risk their child deteriorating further. This is also true for adults with
mental illness and increases the odds that they will ultimately need more
costly care or confinement; hospitalization or incarceration.
What to do? Gov. Cuomo
created the Department of Financial Services, charged with the responsibility
to monitor private health insurers to ensure that they have adequate networks
of care as a condition of their license. This means they must demonstrate the
consistent ability to provide timely access to care for individuals and their
families.
Just this week parents who
came to the Guidance Center after taking their child to the emergency room,
told us that they called no less than 20 different therapists or agencies and
were turned down by all of them. Finally they called another hospital that made
the referral to us. We turn no one away for inability to pay.
This is an all too familiar
story that we hear frequently and that my colleagues from sister agencies tell
me as well. You might wonder why this happening.
Private health insurers pay
substandard rates of reimbursement for mental health and addictions care, as
compared to Medicaid; sometimes 50 percent or less the than the Medicaid rate.
Consequently, participating providers bail out because they cannot afford to
accept such low rates. The insurers fail to carefully monitor their lists and
the state fails to monitor and regulate the insurers.
In the case of delayed care
for a child, this represents corporate and state child abuse.
I have reached out
repeatedly to the governor, attorney general and numerous state legislators to
issue a call to action to demand that DFS do their job. There is sympathy, but
no action.
Andrew Malekoff is executive
director of North Shore Child & Family Guidance Center in Roslyn Heights.
If you subscribe to Long
Island Business News: http://libn.com/2016/03/04/malekoff-li-families-cant-afford-to-wait-for-mental-health-services/
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