Obstacles / Denials of Another Kind
Cover My Mental Health provides support for the most common insurer obstacles to mental health care.
We recognize that some insurance obstacles may be less common or more confusing or both.
For obstacles or denials “of another kind”, Cover My Mental Health’s guidance offers potentially helpful actions to improve access to care.
Action Plan
With insurer feedback such as the above, check out Denied: not medically necessary.
Different level of care pushback may look like these:
- Fewer appointments are approved than the provider has determined is appropriate
- Only out-patient care is covered, when the provider has determined that intensive out-patient or partial hospitalization is appropriate.
- At higher levels of care (for example, in-patient), an insurer determines that enough progress has been made, so a lower level of care is now appropriate; the provider does not agree.
- At higher levels of care (for example, in-patient), an insurer determines that not enough progress has been made, so that care is no longer covered; the provider does not agree.
- Intensive out-patient care is not covered, but out-patient care is covered
Maybe.
Best to have a complete copy of your insurance policy. See Action Plan “Request a complete copy of your insurance policy”
Ask a customer service rep exactly where in the insurance policy they see an exclusion or reason to say the care is not covered.
- See Action Plan for “Tips when talking with insurance company customer service reps”
Still not clear? Consider asking for help from your employer or filing a formal insurer complaint.
This may be quite frustrating… whether they are unclear about your care or a claim or a denial.
It may be helpful to have a complete copy of your insurance policy. See Action Plan “Request a complete copy of your insurance policy”
Ask a customer service rep exactly where in the insurance policy they see an exclusion or reason to say the care is not covered.
- See Action Plan for “Tips when talking with insurance company customer service reps”
Still not clear? Consider asking for help from your employer or filing a formal insurer complaint.
We welcome inquiries about other insurance obstacles at [email protected].
Please do not share urgent requests, though we will endeavor to respond on a timely basis. Please do not share personal health information in your email; see our Privacy Policy.
Cover My Mental Health does not provide medical or legal advice.
Inquiries about other insurance obstacles may help us to expand and improve the resources provided on this site. Thanks.
