Kimberly Ramsey is the board chair for American Foundation for Suicide Prevention Delaware. Angela Kimball is the chief advocacy officer of Inseparable.
Delaware is facing a mental health crisis. Across the state, 165,000 adults — four times the population of Dover — live with mental health conditions. Each year, 15,000 Delaware teens face major depressive episodes, and 10,000 adolescents have serious thoughts of suicide. All the while, our insurance plans refuse to cover the mental health care that we need and pay for. One Delawarean explained, “Dealing with insurance has often felt like fighting another battle on top of getting care. … It doesn’t feel fair when your health depends on paperwork.” Someone else called the process “so complex it makes me not even want to seek care.”
At American Foundation for Suicide Prevention Delaware, we hear similar stories from people across the state. People pay their premiums every month, so, when they need the care their insurers promise, it will be there. Instead, people report that, while trying to get care approved, they are passed from one department to another, receiving different answers in each. If they do manage to get approvals for the doctor-prescribed treatment they need, they sometimes have to wait weeks or months to get it. Even worse, if they have to appeal wrongful denials, it can take at least another 45 days. The added stress of navigating these insurer-imposed hurdles is the last thing someone needs when they are already struggling with their mental health.
These stories are borne out by the data. According to new research by Inseparable, more than 25% of Delawareans who have sought mental health or substance use care say insurance has made it more difficult to get, with younger patients — those who are struggling the most — facing significant barriers. Of that 25%, a significant majority said that insurance decisions have created financial burdens for their families.
Not only do insurance companies impose skyrocketing premiums, but their policies and rules — which have led to provider shortages, denied claims and discontinued treatment — have forced many to seek care from out-of-network providers. In fact, Delawareans are five times more likely to go out-of-network for mental health care than for medical care, making mental health care harder to get and far more expensive for so many families.
But financial strain is just one of many consequences of insurers’ negligence. By delaying and denying treatment, insurers avoid paying for the care that their customers need. They don’t update provider directories, leaving patients with out-of-date contact information that makes it nearly impossible to reach the providers. According to our research, only 1 in 4 people could actually get an appointment with the provider they found in their insurance company’s directory. Even when patients can reach providers, the providers are stretched thin, and therefore, patients often have to wait an unacceptably long time for appointments. In Delaware, the average wait time patients report is nearly 23 days, with 1 in 10 patients waiting more than 10 weeks for care.
Denying, delaying and cutting short mental health treatment can turn manageable conditions into emergencies, leading to hospitalizations, overdoses or even death. It can increase the likelihood of unemployment, homelessness, emergency room visits and incarceration. This endangers patients. And, though it might seem like a cost-saving measure initially, it actually imposes much higher costs down the line for the patient, the insurer and the community.
Delawareans deserve better. We deserve insurance coverage that will actually help us and policies that protect us from insurers’ disregard. In California, Oregon, New Mexico, Maryland, Illinois, Colorado and Washington, policymakers have fought to ensure equal coverage for all mental health and substance use conditions, and guarantee that mental health emergencies are covered, just like broken bones or heart attacks. These policies require insurance companies to use transparent clinical guidelines when determining coverage for treatment, so mental health care decisions are based on medical best practice, not corporate profit margins. They require coverage of out-of-network care when in-network care isn’t available, ensuring that patients can access the care they need when they need it. It’s time for Delaware to do the same. In fact, there’s one area where Delaware could lead the nation. Currently, the state limits prior authorization requirements for addiction treatment; it should extend those limits to mental health care decisions, too, because no one should have care delayed when they are in crisis.
Delawareans are struggling — you’ve told us yourselves — and you deserve more: more from your insurance companies and more from your state. It’s time for state policymakers to stand up and fight for affordable, accessible and reliable mental health care for every single child, teen and adult in Delaware. It’s time to show what it means to put the First State first.
Reader reactions, pro or con, are welcomed at civiltalk@iniusa.org.
