hospitalization tagged posts

The government may not be open for business, but the market exchanges and 24 hour phone lines are operating today!

Marking today’s opening of the health exchanges, Care for Your Mind shares information and resources about who has to have insurance, what’s involved in enrollment, and what we know about mental health care coverage.

Millions more will now have access to mental health care

If you’re looking for health insurance, you have some new options! Today the health exchanges are open for business. That’s because today is the first day of the enrollment period for the health exchanges established under the Affordable Care Act (ACA) to enable the purchase of health insurance.

Here we are providing links to information covering the individual mandate, enrollment in a health exchange, and what is currently known about mental health coverage. Do you know how the ACA is changing health care?

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Carol McDaid
Winning strategies for filing a mental health insurance coverage grievance

CFYM Note: This is the last in the series by Carol McDaid on your rights with regards to mental health insurance parity laws and expanded coverage under the Affordable Care Act. Tuesday’s post provided an overview of what types of denials to look out for. Today, Ms. McDaid tells readers how to file a grievance for denial of mental health insurance coverage.

When should I file an appeal

Mental Health America compiled this list of questions to help you understand if you should appeal a coverage denial. At first glance, the questions may seem to require a sophisticated understanding of your plan and the law, but you can simplify it this way: If the answer is YES to any of the following questions, the plan is most likely not in compliance with the new laws.

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Carol McDaid
Parity Implementation Coalition

Follow these practical steps to win your appeal.

CFYM Note: Last week, Carol McDaid answered the question, “Doesn’t health insurance have to cover mental health care?” She also described steps to make sure you’re getting all the health care benefits you should. This week, Ms. McDaid covers what the mental health parity law means for you when you don’t get the benefits you’re entitled to.

From promise to reality

The fact that we now have two federal laws requiring mental health parity is cause for celebration—both for those of us who spent years advocating for the laws and those of us, me included, who have been denied coverage by our insurance plans.

The Mental Health Parity and Addiction Equity Act was signed into law in 2008. The Affordable Care Act goes into effect January 1, 2014, and will require more plans, including those in the newly created health insurance exchanges, to offer mental health parity. (Read more about the laws in Part 1 of this series.)

The federal laws are on top of state laws that exist in approximately 40 states to protect people from being denied mental health benefits through public and/or private employer-sponsored health insurance. (View a chart of state mental health parity laws from the National Alliance on Mental Illness.)

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On Tuesday, inspired by Labor Day, we looked at three mental health policy issues for employees. One of those was the declining number of people who have health insurance through their work.

What are the ramifications for people who do not have employer-sponsored health insurance?

Today, two members of the CFYM community describe their struggles to access mental health care services in the absence of employer-sponsored health insurance. After her health insurance through COBRA ran out, Janet faced the prospect of highly-restrictive coverage, then no coverage...

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Families for Depression Awareness

As family caregivers and caring friends of people living with mood disorders or other mental health conditions, we want to help our loved ones by

• keeping them safe
• getting them care to get well; and
• preventing suicides.

Sometimes people are in a state of mind that prevents them from making sound decisions. There are mental states (e.g., experiencing psychosis) and physical conditions (e.g., effects from a stroke) that can adversely affect a person’s usual good judgment. We agree with DBSA and others that, ideally, a person with a mental health condition will engage family members and friends as partners in wellness and in crisis. There will be a written plan and the legal documents necessary to ensure that care is pursued and provided according to the individual’s wishes as expressed when he or she was well. Mental health practitioners can make sure that families get information about this and should strongly encourage patients to bring a family member to at least the first appointment.

The Reality

In our experience, all too often these conversations and pre-planning have not occurred, and the family member must navigate the complex medical, insurance, and legal systems to get emergency care for their loved one.

Family members are frequently excluded from mental health care decisions, despite being the ones who often have the most pertinent knowledge and the greatest motivation to get someone the care they need to get well.

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Depression and Bipolar Support Alliance

When an individual with a mental health condition in need of intensive psychiatric care is hospitalized, whether voluntarily or involuntarily, the individual, family, and friends may have mixed reactions. They may feel relief that the individual is safe, but they may also feel emotionally, physically, and potentially financially drained. Yesterday on CFYM, Dr. Sederer shared his expertise in navigating what can be daunting legal and medical legalities on patient psychiatric hospitalization treatment rights. DBSA believes that patient protections are important to ensuring individuals are the lead decision-makers in their own wellness. The best wellness outcomes are achieved when individuals living with mental health conditions and their family and friends are educated and prepared for crisis.

Education is Power

DBSA encourages individuals to become knowledgeable about (1) mental health laws in the states in which they reside; (2) options for treatment centers and outpatient programs other than hospitals; and (3) the rules and regulations regarding admission and release in hospitals and treatment facilities, both for voluntary and involuntary entry.

Whether hospitalized voluntarily or involuntarily, individuals have the following rights:

1. to have treatment explained;
2. to be informed of benefits and risks of treatment;
3. to refuse treatment the individual feels is unsafe;
4. to be informed about any procedures that the individual feels may be unnecessary; and
5. to refuse to take part in research and experimental treatments, and to disallow students or observers.

DBSA supports adherence to these patient rights in all circumstances.

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Lloyd I. Sederer, M.D.
Adjunct Professor, Columbia/Mailman School of Public Health
Medical Editor for Mental Health, Huffington Post/AOL

All patients have both a right to treatment and a right to refuse treatment. These rights sometimes become the centerpiece of debate and dispute for people who are hospitalized with an acute psychiatric illness.

The Right to Treatment

There is a long legal history on the right to treatment. Much of the law derives from court cases in the previous century involving people who were admitted to state psychiatric hospitals where they languished without proper treatment, sometimes for many years. Laws compelling a right-to-treatment law developed and became instrumental to the quality-controlled public psychiatric hospitals that exist today. In fact, in order for public psychiatric hospitals to receive Medicare and Medicaid (and other third-party) payment, they must obtain the same national certification as academic medical centers and local community hospitals. For patients and families, this means that a person admitted to a public psychiatric hospital has a right to receive—and should receive—the standard of care delivered in any accredited psychiatric setting.

The Right to Refuse Treatment

It may seem odd that a person can be involuntarily admitted, or “committed,” to a hospital and then refuse treatment. But the right to refuse treatment is also fundamental to the legal requirements for psychiatric treatment.

Someone who enters a hospital voluntarily and shows no imminent risk of danger to self or others may express the right to refuse treatment by stating he or she wants to leave the hospital. But a person admitted involuntarily, due to danger to self or others, cannot leave, at least not right away. However, despite having the authority to keep the patient in the hospital, the professional staff cannot treat the person against his or her will, except by court order.

The concept of a right to refuse treatment was built on basic rights to privacy, equal protection under the law, and due process. In other words, involuntarily hospitalized patients still have a right to decide what happens to their bodies.

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