NJ Parity Coalition, National Alliance on Mental Illness
My name is Rocky Schwartz and I live in Lebanon, New Jersey. I am a member of the NJ Parity Coalition, NAMI (National Alliance on Mental Illness) and co-chair of the NJ Behavioral Health Planning. I am married and the proud Mom of two sons who are remarkable and resilient young men who have suffered with substance abuse and mental health disorders for the past 6 years. My sister died of an overdose at the age of 39 over 10 years ago. I am a person in recovery from addiction for 35 years. In 1982, my parents did not have to take out a home equity loan to pay for my medical treatment. I am grateful to be here today and hope that other families in will not have to struggle getting medical help for their loved ones like we have.
In the interest of time, I will share two examples of the seven insurance denials.
Two years ago, one of my sons was discharged from an outpatient program despite recommendations from the clinical staff that he was mentally unstable and high risk for relapse. He was 1000 miles away and alone for the first time at Christmas. He was so despondent that he attempted suicide 2 days later. After a brief 48-hour hospitalization, a judge ordered him to more intensive treatment for his safety. The insurance company refused to pay for even one day of inpatient care. We paid for his medical care and have lost all insurance appeals for this hospitalization.
One year ago, my other son was court ordered into treatment after first responders intervened on his behalf. The insurance company denied his care after 12 days of inpatient treatment. The clinical notes in the 220-page medical record stated that the doctors recommended continued residential stay. We paid out of pocket and the U.S. Department of Labor is reviewing the appeal.
He had asthma when he was a child and frequently needed to be hospitalized. Not once was he ever denied the medical care that the doctors recommended. Nor was he judged for not caring for his body or blamed for his illness.
We have spent over $300,000 in the last 6 years for my son’s medical treatment. We borrowed against our home, cashed out college savings accounts and withdrew money from our retirement fund to pay for treatment. The NJ Catastrophic Illness in Children’s Relief Fund awarded us $157,000 for medical expenses.
The medical necessity denials are not clearly defined. The process of filing appeals for insurance denials is a painstaking, time-consuming one. I have spent hundreds of hours writing letters, researching, copying, faxing and STILL lost every appeal.
I cannot change the past and doubt that any of my insurance appeals will be resolved. My hope is that I can prevent other families from suffering the financial, physical and emotional toll that we have. I am one of the lucky ones. I represent many other Moms who have lost their sons and daughters to these illnesses. The added stress of fighting for our rights as consumers is unconscionable and frankly fraudulent. I ask that you support legislation to enhance enforcement and oversight of the mental health parity laws.