California bill would address unfair denials of youth mental health treatment / Public News Service

Children’s advocates are pressuring California lawmakers to pass a bill that would increase oversight of health plans when they deny mental health services to children. Currently, parents must request a review from their health insurance plan when a child’s mental health condition is not covered by their insurance – and if service is still denied, they can request to the State an independent medical examination.

Lishaun Francis, senior director of behavioral health at the nonprofit Children Now, the bill’s sponsor, said it’s a critical issue.

“This bill states that if plans deny care from a youth mental health service, they must automatically review that refusal, rather than a parent calling and asking them to take a second look. If it is an emergency service, this examination is transmitted to the state automatically,” she explained.

The California Association of Health Plans opposes the bill, arguing that additional testing could delay care and generate more unnecessary costs in the health care system. Case histories posted on the state Department of Managed Health Care website suggest that the types of services most commonly denied by health plans include residential mental health treatment and medication or surgery for gender dysmorphia.

Francis said when parents escalate their fight to an independent medical examination, they often win.

“Nearly 70% of all claims that come into the state are overturned through the independent medical review process, which tells us that a lot of this is something health plans should actually cover,” she declared.

Senate Bill 294 would also require the state to make public the number of independent medical review requests it receives each year and how they were resolved. The bill has already passed the state Senate and is now before the Assembly Health Committee.

Disclosure: Children Now/KIDS COUNT contributes to our fund for reporting on children and youth issues. If you would like to help support public interest news, click here.

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