What to do if you're denied insurance coverage for treatment.

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Can insurance companies deny coverage for addiction treatment? In this video we'll learn what to do when our insurance won't cover treatment, and share information and resources that are available to help individuals and families who are facing insurance denials for substance use disorder care. With Lindsey Vuolo, J.D., M.P.H., V.P. of Health Law and Policy at Partnership to End Addiction, Maureen O'Reilly, J.D., and Andres Mendez of the Employee Benefits Security Administration (EBSA) at U.S. Department of Labor.

Chapters:
00:00 Introduction
00:41 About the Mental Health Parity and Addiction Equity Act (MHPAEA)
02:16 Introducing Maureen O'Reilly, J.D., whose son, Ed Fahy, was denied lifesaving care
03:22 Introducing Andres Mendez, benefits advisor at the U.S. Department of Labor
04:08 Maureen's story about her son Ed Fahy treatment denial
07:33 What happened when Maureen tried to get treatment for Ed?
08:53 Horizon Blue Cross Blue Shield of New Jersey told her Ed had to leave detox
09:15 That they thought he could detox at home was unbelievable
10:08 Notified again by Horizon that Ed had to leave and should recover at home
12:51 After 30 days in rehab in Florida, Ed was sent to a sober house
13:37 At a 3rd sober house, Ed relapsed and died of fentanyl poisoning
16:19 What did Maureen do when Ed was denied treatment?
18:12 Learning during lawsuit that Ed had been improperly denied care
19:20 Ed's policy was expensive and claimed to fully cover addiction care
21:52 Settlement with the company in 2020
23:05 Maureen's advice to other parents going through similar experiences
31:10 Andres explains what Employee Benefits Security Administration is
32:09 Provisions under the Mental Health Parity and Addiction Equity Act
33:16 What specifically does MHPAEA protect?
34:38 Red flags that an insurance plan may be in violation of MHPAEA
36:18 About nonquantitative treatment limitations
38:21 Andres' advice to individuals being denied care
42:16 What can EBSA actually do for you?
45:00 What do benefits advisors at EBSA do?
48:40 What type of health plans does EBSA have jurisdiction over?
53:12 EBSA is a public resource so please take advantage of it
55:45 Conclusion

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Partnership to End Addiction is a national nonprofit providing personalized support and resources for families impacted by addiction. With decades of experience in direct services, communications and coalitionbuilding, we mobilize families, policymakers, researchers and health care professionals to more effectively address addiction systemically on a national scale. For more information, visit drugfree.org.

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Disclaimer: The views and opinions expressed in this discussion are those of the participants and do not necessarily reflect the official policy or position of Partnership to End Addiction.