The following information is provided by Karie Dove regarding her attempts to seek mental health treatment for her daughter through insurance company Blue Cross Blue Shield of Oklahoma. The information is in Dove’s own words, with edits for style and clarity. Blue Cross declined comment on Dove’s statements, citing patient privacy laws. Read the Oklahoma Watch story about the Dove family and mental-health treatment issues.
These were all the inpatient claims filed prior to the Affordable Care Act insurance policy. In (the daughter’s) insurance benefit booklet for this plan it clearly states: “Benefits for the treatment of any of the following Severe Mental Illnesses shall be equal to the benefits provided under this certificate for treatment of all other physical diseases and disorders: Schizophrenia; Bipolar Disorder (manic-depressive illness); Major Depressive Disorder; Panic Disorder; Obsessive-Compulsive Disorder; and Schizoaffective Disorder.”
Psychiatric care services: Covered services for treatment of severe mental illness – in-network 80/20 percent coverage, out-of-network 60/40 percent coverage.
April 2012, Red Rock Crisis Center: Total inpatient days: 7. Was released per doctor orders; state paid completely.
Sept. 17 – Sept. 28, 2012, Cedar Ridge Mental Hospital (Oklahoma City): Total inpatient days: 11. Was released against doctors’ and therapists’ advice because the insurance company refused to pay for any more inpatient days. Insurance did pay the bill completely.
March 13 – April 25, 2013, Children’s Recovery Center (Norman): Total inpatient 44 days. Was released per doctor’s orders, they requested her go to a long-term residential treatment facility. Insurance processed this claim and only paid 19 days.
April 29 – June 8, 2013, Four Winds Ranch (Guthrie): Total inpatient days: 41. Was released against medical advice because insurance would not pay and we could not afford any more ($8833.00 per month). We did self-pay because Four Winds said we would be able to get a self-pay discount and our insurance stated we did not have any inpatient benefits available. Four Winds said they would give us printouts of everything needed so we could file with our insurance. I did file with our insurance and they denied all of it.
July 1 – July 25, 2013, Children’s Recovery Center (Norman): Total inpatient days: 25. Was released per doctor’s orders. CRC filed precertification paperwork with insurance company. They pre-approved 24 total days. Once the claim was filed, the insurance denied entire claim.
Nov. 6 – Dec. 19, 2013, Children’s Recovery Center (Norman): Total inpatient days: 45. Was released because she was turning 18 and they could no longer treat her since it was an adolescent facility. Insurance denied the entire claim.
Jan. 1, 2014: (Note: Affordable Care Act regulations on essential benefits, which include mental health care, goes into effect for small group and individual plans. Federal mental health parity requirements cover these benefits. Dove’s daughter was on an ACA Gold PPO plan with a $1,000 deductible and $3,000 out of pocket maximum.)
April 2 – April 11, 2014, The Referral Center (Oklahoma City): Total inpatient 10 days. Was released per doctor’s orders. TRC informed us since we had insurance on (her) (even though she was homeless/indigent) they would not give her a state bed. We were also told they could not take any insurance except Health Choice (the state employee insurance plan) per state rules. She was not allowed to be admitted unless we paid the $4,000 fee for her stay. They would be happy to give us a print-out for us to file with our insurance. I filed this with insurance and they covered $97.11, which went to our deductible, denied the rest.
June 11 – July 29, 2014, New Hope Rehab Center (Sayre): Total inpatient days: 49. Was released per doctor’s orders. New Hope filed pre-certification and was approved (for) 21 days; they refused to approve any more. We appealed for more days and were denied. Once the claim was filed, the insurance denied the entire claim. We appealed this and also went to the Oklahoma Insurance Department and filed a complaint. They (insurer) finally paid it up until the date they refused to pay for any more days (the 21 pre-approved days), stating she was ready for a lower level of care. (Note: During the time period the facility was appealing the insurance company’s decision not to provide any more pre-approved days, the state was covering the cost of her stay, Dove said).
Aug. 6 – Aug. 16, 2014, Norman Regional Behavioral Center: Total inpatient days: 11. Was pre-certified for at least seven days. They (insurance) did pay this.
(After Dove stopped paying for her daughter’s insurance, the state begain picking up the tab, including for visits to a crisis center at Griffin Memorial Hospital in Norman.)
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