by Suzanne Potter
California News Services
Children’s advocates are pressing California lawmakers to pass a bill that would increase oversight on health plans when they deny mental health services for children. Right now, parents have to ask their health plan for a review when a child’s mental health condition isn’t covered by their insurance – and if service is still denied, they can ask the state for an independent medical review.
Lishaun Francis, senior director of behavioral health with the nonprofit Children Now, a sponsor of the bill, said this is a critical issue.
“This bill says if plans deny care for a Youth Mental Health Service, they have to automatically review that denial, as opposed to a parent calling and asking them to take a second look. If it is an emergency service, that review goes to the state automatically,” she explained.
The California Association of Health Plans opposes the bill, arguing that the extra reviews could delay care and build more unnecessary costs into the health care system. Case stories posted on the state’s Department of Managed Health Care website suggest the types of services most commonly denied by health plans include residential mental health treatment, and medication or surgery for gender dysmorphia.
Francis said when parents escalate their fight to an independent medical review, they often win.
“Almost 70 percent of all claims that make it to the state get overturned by the independent medical review process, which tells us a big chunk of this is something that health plans should actually be covering,” she said.
Senate Bill 294 would also require the state to make public the number of independent medical review claims they receive each year, and how they were resolved. The bill has already passed the state Senate, and is now before the Assembly Committee on Health.
