The Challenges Faced By Professionals Filing Mental Health Claims
With mental and substance abuse disorders being the leading cause of disability worldwide, insurance companies are very keyed into how they can save money on mental health claims. As we’ve discussed before, many policies, especially newer ones, contain mental health disorder and substance abuse limitations that expressly limit the amount of benefits the policyholder can receive (typically to 12 or 24 months), and some even contain exclusions that prevent policyholders from collecting benefits at for mental health conditions alltogether.
Even if your policy doesn’t contain these limitations, insurance companies subject mental health claims to close scrutiny, and some insurance companies have even established specialized departments that exclusively handle mental health claims. These departments are made up of claims consultants who have additional, specialized training, vocational consultants, and in-house psychologists and psychiatrists. The primary goal of these departments is often closing claims by returning claimants to the work force.
While many professionals are able to return to work in their prior occupation after receiving mental health treatment, that is not always the best option for everyone. For some professionals—for example, the dentist with anxiety or the emergency room doctor with PTSD—even the thought of being forced to return to work can send them into a downward spiral, and undo any progress that they have previously made in therapy.
Oftentimes, the first thing that the insurer’s mental-health team will do is contact your providers and challenge the appropriateness of your treatment and/or push for a return-to-work timeline. If you’re treatment provider has never dealt with an insurance company before, he or she may feel pressure to push for unrealistic goals and/or exaggerate progress, which can in turn interfere with treatment and/or lead to a strained patient-therapist relationship. Consequently, it is important to find a treatment provider who will stand up to your insurer and provide a fair and realistic account of your progress. If an insurer is being particularly aggressive, it can also be helpful to have a disability insurance attorney step in and rein-in the scope of the insurance company’s investigation to an appropriate level.
Those suffering from a mental health disorder can find resources for immediate help at mentalhealth.gov.
 10 Facts on Mental Health, World Health Organization, http://www.who.int/features/factfiles/mental_health/mental_health_facts/en/index1.html.