Anyone had problems getting pre-authorized for mental healthcare?

I have been going through (insert bad word here) with a 3rd party insurance company with getting pre-authorizations for my mental healthcare. It has been a sheer nightmare.

But the thing is, every single time I have tried to get help before, and now just when I'm switching insurance due to a job change, it has been horrible. Bad enough the first time that it kept me from getting help for 2 years, which could have killed me.

Is it just me, or has anyone else had this problem too?

Do you know what agency we need to go to to FIGHT these companies??

I am not going to just sit and let them treat me like this again. Never again. It should not be this hard to get mental health treatment.

They messed with the wrong girl this time. I will not let it go.

Problem is....my employer is self-insured, so I can't complain to the state insurance board. So who CAN I complain to? And it's not my insurance company I'm mad at, it's the 3rd party that pre-authorizes mental healthcare. Who regulates them? How do I find out?

I want to get them in trouble, and not just a slap on the face.

But I don't know how.

Oh, and I don't want my employer to find out I'm crazy in the meantime.

Are they not authorizing services? Or not as many as you would like? I'm not sure from your post what specific issues you're having with your insurance administrators.

I don't use insurance now. Life is much more pleasant when I leave insurance out of my therapy. But in the past, I have just played their game to get what I needed. No matter what was going on with me, I called it depression because depression is a prevalent and acceptable diagnosis. It got me in to see the therapist, and then the therapist knew how to take it from there.

Remember that you can always request an appeal or a "reconsideration" even with self-employed insurance. This is your best recourse.

Also, as difficult and as counter intuitive as it may sound, try your best to be "sticky sweet" to the staff. At larger public companies, these workers can get threatened with lawsuits, media coverage, etc, on a daily basis so much that they can become immune and disconnect to the members' problems and instead just react to their anger.

NCQA licenses these companies but this is not the route you want. They largely do retroactive reviews and are not as involved in day-to-day procedures.

Attempt to gain the workers' empathy and access all levels of available internal appeals.

I think the Oregon Health Plan http://www.oregon.gov/DHS/healthplan/ is unique so problems you have should be addressed to DHS? I don't think the third party thing is the way most people do mental health insurance in other states.

I've dealt with companies like this in the past, when I lived in another state, so it's not unique to Oregon. And they treated me like crap then too.

When I posted the name of the company before it got deleted so I can't post that....but it's not your health insurance company, it's a 3rd party that contracts with your health insurance to pre-authorize mental health services. Basically, you can't just go get an appointment by yourself, you have to call and go through a process to get authorized before you can get services.

I guess I'm the only one who has to deal with this? It's been this way every time I try to get help, and now when I'm switching insurance due to a job change.

The best I can come up with is a complaint to the Better Business Bureau....but whoop-de-do, they won't do anything.

It just shouldn't be this hard to get help.

So the problem is dealing with the 3rd party, to get the authorization? I hear your frustration, but I am still not understanding the issue exactly.

I don't like the intrusiveness of the authorization process, or the "watchdog" role of the insurance company, which is why I don't use insurance for my therapy (also, there is a huge deductible, so I would be paying cash anyway).
Between having to 'prove' I need the services and the limits on treatment and providers, I suspect the whole idea is to discourage a person from using the benefit. It looks good on paper ("We offer mental health benefits") but reality is something else.

I'd complain to the health insurance that you don't like the 3rd party they use and will be suggesting your company (or whoever buys the health insurance) that they switch providers to one who's mental health benefit works easier.

Keep in mind that the self-funded company *may* be fully aware of how the mental health benefits administrators do their job. They may have been contracted to be strict gatekeepers to keep costs down.

I'm saying contact the second party company (first party is who you work for) and fake an influence on your employer, the first party company. Imply that you can impact the second party company's business (because you don't like the 3rd party) by convincing your employer to go with another firm that has better 3rd party care.

Since you're just changing jobs now, I don't know that that will work, sounds like you just got a job with a company who buys lousy insurance and, since you just started working there, don't have any leverage to use in fact.

I had great health insurance but my company wanted me to work part-time to save money. However, because of my past history with the company and good service to them, I was able to negotiate so I kept my insurance, as if I were still full-time.

I am in the insurance business, but that does not mean I understand it all. What I would do is get it in writing why you were denied. Find out what your coverage entails. Then you can see if you have a leg to stand on. I am not saying what they are doing is right, but you might not have the coverage you thought you had.