Dear Insurance Member:
In the past, you have received services to help you manage your diabetes. As your insurance company, we now have decided that diabetes is not as serious as heart disease. Since we want to have more funds available to treat heart disease, we will no longer provide insurance reimbursements for your diabetes needs. We won’t pay for your doctor visits to address your diabetes (unless you also have heart disease). We won’t pay for your medications, tests, insulin, nutrition education, care management, or other supports to keep your diabetes from becoming worse. We have not contacted your primary care provider about this decision, so you will need to call the PCP office to let them know about our decision.
Based on this new policy, you may or may not continue to get services. You might be eligible for different services. Members do not have the right to appeal these changes in our rules.
Your Insurance Company
If you had diabetes and received a letter like this from your insurance company, no doubt you would be surprised, frustrated, and frightened about your future health outcomes. You might call the Bureau of Insurance or your legislator to complain. Newspaper articles would question such a policy change and its long-term impact on people’s health and the increased cost of waiting until people’s health declined to a level requiring emergency level care. A public uproar might follow such a decision.
Yet, something very similar is happening to people experiencing serious mental illness. On March 1, many people receiving mental health services through the MaineCare program were sent a letter saying MaineCare would no longer pay for their Section 17 treatment and services for their serious and chronic condition, unless they had a primary diagnosis of schizophrenia or schizoaffective disorder. If they had serious depression, posttraumatic stress disorder (PTSD), anxiety, or other serious mental health conditions, their Section 17 Community Support Services such as intensive community case management could be discontinued. Over 8,000 Mainers could be impacted.
Section 17 Community Mental Health Services providers report they had not been informed of this decision before their clients received this notification, so they were unprepared to help answer questions and assist their clients to prepare for this change. In fact, most providers discovered the change when clients called them in a panic about the letter.
This policy decision suggests that people coping with one chronic and serious mental health illness are more deserving of treatment than others are.
But, tell that to the over 22,000 people with depression who died of suicide in United States in 2014. In fact, ninety percent of the total of all 42,773 people who died of suicide in 2014 had a psychiatric disorder at the time of death.
And, tell that to the 25 million Americans who suffer from depression each year. Depression is the world’s leading cause of disability, and certainly qualifies as a serious condition requiring ongoing treatment and community support to prevent deaths.
What about the almost 8 million American adults, many of them veterans, who suffer from PTSD in a given year? This includes the 30% of people who have spent time in war zones and later experience PTSD. Isn’t their health worthy of funding?
Most people experiencing mental illness are treated with medications and behavioral treatments that help them recover and be highly functioning. Still others have serious and persistent mental illness as an ongoing health condition that requires more intensive care and supports, including community support services. Under the new policy, people with mental health conditions such as serious depression and PTSD might not receive the Section 17 supports they need to recover and become healthy and functioning.
People with Schizophrenia or Schizoaffective Disorder benefit from and should continue receiving Section 17 Community Support Services. So should those who experience serious and persistent depression, PTSD, anxiety, traumatic brain injury, and other serious mental illnesses.
Just as we cannot pit one medical condition such as heart disease against another such as diabetes, we should not imply that one diagnosis of serious mental illness is more deserving of treatment than another. We need to support people experiencing all types and diagnoses of serious mental health disorders with adequate and appropriate treatment, care and community supports. Lives depend on it.
Thank you for contacting us!
Our group will review and follow up within 72 hours.
Thanks for your interest!