A Family Member's Legal Experience With an Insurer's Refusal to Recertify Inpatient Mental Health Treatment




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My son Nathaniel has bipolar disorder and was hospitalized for 6 months, during which time our insurance company was prepared to refuse certification more than once despite a policy that included 365 days of inpatient mental health treatment. A break in coverage by the insurance company would have meant that Nathaniel, still suicidal, would not receive the life-saving care he needed. Fortunately, I am a lawyer, which enabled me to act as a legal advocate for my son when our insurer threatened not to recertify. Because my son’s experience with the insurance company is not unusual—many patients with mental illness struggle with insurance companies who refuse to certify treatment—I believe that the family or support people of seriously ill psychiatric patients should be prepared to act in circumstances similar to mine. Psychiatric inpatient units should, as a matter of course, provide information on legal remedies that can be obtained before irreparable harm occurs.

J Clin Psychiatry 2001;62(suppl 25):44-50