Colorado bill would help people navigate insurance system

Posted at 10:56 PM, Apr 03, 2018
and last updated 2018-04-04 01:25:03-04

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DENVER — A bill expected to be introduced this week would make it easier for Coloradans to get mental health care by creating a state ombuds office to help people navigate the insurance system.

"When I was 11 years old, was the first time I was suicidal," said Aubrey Boggs, who has lived with mental health conditions for much of her life. When symptoms resurfaced recently, she tried to get help.

"Through my insurance carrier, I started looking for a therapist, and I was unable to find one," she said. "I made more than 50 phone calls."

Boggs said some providers weren't in-network, even though they were on her insurer's list. Some didn't have appointments for months. Some didn't call her back. And her insurance company wasn't any help, either.

"You guys are supposed to be providing these benefits to me. We pay into this. We're supposed to be receiving these benefits," she said. "It was horrible."

Andrew Romanoff, President and CEO of Mental Health Colorado, said it is a problem that is reaching a crisis point, with more than half-a-million people in Colorado not getting the care they need, even though the law states people should be able to access care in seven days (or in urgent cases 24 hours.)

"When we tell folks those laws and those rules which are now in place in the state, they laugh us out of the room," said Romanoff. "'Seven days would be great, but I'd settle for seven weeks, I've been waiting for seven months.' Seeking care doesn't do any good if you can't find it."

The bill his organization is supporting aims to change that by creating a state mental health ombuds office, an advocate to help people navigate the system. It would serve as a central point for people and providers in need of assistance with claims.

The bill would also require insurers be more transparent about what they're doing to comply with laws that require equal coverage for mental care and physical care.

Even though insurance carriers are required to maintain adequate networks of providers, a recent study shows Coloradans go out of network for mental health services seven times as often as for physical care and that mental health providers have reimbursement rates 40 percent lower than other healthcare providers.

Romanoff said the bill to be introduced would reflect a recent report by the President’s Commission on Combating Drug Addiction and the Opioid Crisis, which urged state and federal regulators to require health plans to document and disclose their compliance strategies.

Romanoff said the measure has early bi-partisan support.

"We've talked to Democrats and Republicans in the House and Senate who are desperate to do something," said Romanoff. "The truth is, it's a lot cheaper to treat mental illness than ignore it."

Meanwhile, Boggs ended up switching to her husband's insurer to get the treatment she needed, and she said people like her shouldn't have to find a mental health condition and their insurer to get the care they're entitled to.

"People want help, and they seek it out, and they can't get it," said Boggs. "And it's really difficult to keep trying when you try so many times, and you can't get the help that you need."