Articles Posted in Mental Health

Kantor & Kantor has established a regular, live, and interactive Zoom conversation to discuss generally and answer questions from the public about long-term disability, health insurance, pensions, life insurance, casualty (homeowners), and more.  BenefitsChat will be live on Wednesday evenings from 5:00 pm – 6:30 pm Pacific Time.

Host Andrew Kantor, his fellow Kantor & Kantor attorneys, and select guests will explain and discuss everything from “big picture” concepts, such as the distinctions between different ways of obtaining insurance, to case-specific concepts designed to help individuals protect their rights.

While there is always a demand for legal information, current events have created an unparalleled need for as many real, live, helping hands as are available to be lent—even if the hand can only be safely lent via webcam. This forum will give people the chance not only to learn from our attorneys and each other; but to do so within the safety and comfort of a like-minded and supportive group of individuals and their families.

Two decisions this week emphasize the importance of submitting treating physician and patient statements in support of an ERISA administrative appeal. For ERISA health cases involving medical necessity denials, an appeal which gets to the heart of why treatment was medically necessary is crucial and can actually determine the course of the lawsuit.

In Katherine P. v. Humana Health Plan, Inc., No. 19-50276, __F.3d__, 2020 WL 2479687 (5th Cir. May 14, 2020), the Fifth Circuit revived life into a claim by a young woman seeking mental health benefits for partial hospitalization treatment. Katherine received partial hospitalization treatment in 2012 for multiple mental health disorders including an eating disorder. Humana paid for the first 12 days of partial hospitalization treatment and then denied benefits, claiming such treatment was no longer medically necessary based on two Mihalik Criteria.

The Fifth Circuit found that judgment for Humana was improper because the administrative record showed a genuine dispute as to whether Katherine satisfied one of the Mihalik Criteria, ED.PM.4.2.

Even though most of us are still sheltering in place in an attempt to lessen the immediate spread and most severe health consequences of COVID-19, it is not too soon to start considering possible long-term health impacts that may arise in the wake of the coronavirus pandemic.

Because the virus affects many organs and systems within the body – from the lungs and cardiovascular system to the liver, kidneys and likely the brain – it now appears likely that at least some patients will suffer long-term physical symptoms.  These long-term and even permanent problems may result from the virus itself, the body’s own immune response or even medical interventions, especially respirators, or a combination of all these factors.  But whatever the cause, doctors are already seeing heart damage, kidney and liver damage and, unsurprisingly, lung scarring and damage in a number of COVID-19 patients who are no longer actively infected.

And these are still early days. Some patients present during the illness with serious neurologic problems such as strokes and encephalitis, as well as other more mild neurologic symptoms such as dizziness, headache and loss of smell.  There have been reports of some patients suffering from Guillain-Barré Syndrome, an auto-immune disease where the immune system responds to an infection by mistakenly attacking the body’s own nerve cells.  It seems possible that at least some of these patients may continue to suffer neurologic and autoimmune issues, and related pain, fatigue and cognitive difficulties for at least some time.

Millions of people are affected by mental illness each year. While 1 in 5 people will experience a mental illness during their lifetime, everyone faces challenges in life that can impact their mental health. As the increase in the number of COVID-19 cases affects our entire country, so too will the need for access to mental health treatment and awareness of mental health issues. So far, older adults, along with those who have underlying health conditions, have been hit the hardest by the COVID-19 outbreak, with many developing severe, life threatening illnesses. Another group that is expected to be acutely affected by the pandemic include those who have severe mental illness.

Mental illness is a real and treatable set of conditions that includes major depression, bipolar disorder, eating disorders, panic attacks, generalized anxiety disorder, attention deficit hyperactivity disorder, and schizophrenia, among dozens of others. These disorders are serious enough to significantly impact a person’s daily life functioning, whether at school, work or in their relationships with others.

Mental health issues often coincide with a unique set of challenges that make it difficult for people to access even the most necessities, such as food, medications, stable housing, and healthcare. Combined, all these factors put people with severe mental illness at a much higher risk for contracting and transmitting the new coronavirus and dealing with COVID-19.

As we might expect during this time of pandemic, state governments are not able to make progress on many pressing issues. In January, California governor Gavin Newsom unveiled a $47 billion proposal to expand health care coverage to all Californians. However, the coronavirus scourge has sidelined that proposal as California has scrambled to find funds to respond to it.

Due to these funding pressures, Governor Newsom has asked lawmakers to prioritize their legislative agendas and focus on the outbreak. One senator, however, is pushing ahead with a proposal to protect Californians suffering from mental illness.

As reported by Kaiser Health News, California State Senator Jim Beall, who is the chair of the Senate Select Committee on Mental Health, wants to toughen state parity laws to ensure that patients with mental illnesses are provided benefits on par with those received by patients with other medical conditions. California and the federal government already have mental health parity laws on the books, but Senator Beall argues that they are not stringent enough and are poorly enforced.

The COVID-19 pandemic has uprooted the lives of millions of Americans in many ways and has taken its toll physically and mentally on millions of Americans across the country. But for people who suffer from mental health issues, the COVID-19 pandemic has created a new wave of panic, chaos, stress, and uncertainty.

More than 2 million Americans are estimated to be affected by obsessive compulsive disorder (“OCD”), according to the Anxiety and Depression Association of America. Nearly 7 million people in the U.S. are affected by generalized anxiety disorder and about 6 million people in the U.S. are affected by panic disorder. Fear and anxiety about COVID-19 can be overwhelming and cause stress in both adults and children.

Stress during COVID-19 might include:

In this unprecedented time of COVID-19, one thing hasn’t changed: the disparity between medical and mental health care. As a physician is quoted in the New Yorker article, Why Psychiatric Wards Are Uniquely Vulnerable to the Coronavirus by Masha Gessen: “What has really kept me awake at night is that there is always, always less consideration for psychiatric services than for medical services.”

The fact is that mental health treatment is different, it requires patients to decidedly not self-isolate but to be in community for everything from group therapy sessions to meals. Those differences make it harder to treat mental health patients in a global pandemic where isolation and distancing is part of prevention. Health insurers are challenged to accept this new norm, as temporary or permanent as it might be, and adjust its coverage requirements to the reality of evolving treatment settings and protocols.

If you or a loved one is experiencing difficulties working with your insurance company, please call us at 800-449-7529 for a free consultation with one of the attorneys who specializes in getting individuals the mental health care they deserve.

 

For Immediate Release

March 9, 2020

Class Notices are being sent to individuals who were covered under a Blue Shield of California non-ERISA health plan during the period of September 2, 2007 through December 31, 2015, and were denied authorization or reimbursement for residential treatment of anorexia nervosa or bulimia nervosa on the grounds that their plans did not provide coverage for residential treatment.

Parents, educators and clinicians are seeing an alarming increase in mental health problems among young people. An ongoing topic of discussion among educators, medical health professionals and politicians is what can be done to curb this problem.

Following similar moves in Florida, Oregon and Utah, a recently introduced bill in the California State Legislature would allow students time off to treat or attend to mental health needs. Senate Bill 849, written by California State Senator Anthony Portantino (D-La Cañada Flintridge), would allow students in elementary school through high school time out of school to treat or attend to mental health needs without risk of being considered truant, a violation that could lead to penalties for students and fines for parents.  Under California’s current education code, mental and behavioral health problems are not eligible for excused absences.

Studies show that a rising number of school-age children in California are struggling with depression, anxiety or thoughts of self-harm. According to the national Centers for Disease Control and Prevention, suicide is the second-leading cause of death among young people ages 15-24. The CDC reported in 2017 that the number of girls 15-19 committing suicide had doubled from 2007 to 2015. The statistics cited show 5.1 suicides per 100,000 in that age group — a 40-year high. The boys suicide rate in that age group climbed 30 percent, to 14.2 per 100,000, in the same time period.

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Thursday, October 10 is World Mental Health Day. First celebrated in 1992, the day was set up by the World Federation for Mental Health to educate and raise awareness of mental health issues for people around the world.

Each year the event has a different theme. Suicide prevention is the primary focus for the 2019 theme for World Mental Health Day. Here are some key facts and figures about suicide from the World Health Organization:

  • Suicides are preventable.
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