Joe Feldman from Illinois said about nine years ago, his daughter required some serious intervention when she was in high school.
He and his wife got her the care her doctors said she needed, but their insurance refused to pay for it. So, Feldman sued and won. Now, he's determined to help other families.
"We bought health insurance, like anyone, because someday you might need it. And when that moment of truth came, our insurance company wasn't there for us," he said.
The reason?
"The reason was not medically necessary, which was a determination made by a third party psychiatrists that our insurer had hired. Someone who had never met our daughter, never reviewed her files, and didn't listen to her therapist, or her psychiatrist," he said.
The Feldmans' appeal was denied so they ended up paying $100,000 out of pocket, taking money from their savings. Feldman said they had no choice because the treatment was necessary to save their daughter's life.
"Families should not have to go through what we went through to get mental health care for their family members or for themselves," he said.
Feldman won a lawsuit in federal court, but said many others are not so lucky.
He estimates at least 15 million claims for mental health or substance use disorder care are denied each year.
And according to a 2020 survey by the National Alliance on Mental Illness, nearly one in four people seeking mental health treatment are denied coverage by their insurance, leading to untreated mental health issues, worsening conditions and even suicide.
So to help others fight, he's created a non-profit website CoverMyMentalHealth.org.
"The resources of CoverMyMentalHealth.org, which are no cost and immediately actionable, are first and foremost going to be encouraging that you don't have to take no for an answer," said Feldman.
The website provides a step-by-step action plan and tips as well as a downloadable worksheet to document your case and a downloadable template to share with clinicians to prepare a response letter to denials.
"It provides starter text that is essential to a letter like that. And then they can provide that letter to their insurance company," said Feldman.
Feldman said other families with loved ones in his daughter's program had to sell their house or ran out of money and had to withdraw their children.
"The outcomes in at least two cases that she's told me about, were just extraordinarily sad," he said.
Feldman said the guidance provided on CoverMyMentalHealth.org are applicable across all 50 states and across all private insurance.
AHIP is a national association of health care providers. It says, "Health insurance plans are committed to ensuring access to quality, affordable mental health care and have implemented a variety of innovative and collaborative approaches to promoting and improving access."