Relentless: A mother helps other families navigate mental health coverage
From navigating terminology to appeals, a new guide helps others figure out how to get covered
(InvestigateTV) - We open many doors in our lives. But one snowy Maine day, Carmen Bombeke opened the door to her 14-year-old son’s bedroom to a moment no mother, no person, can ever be prepared for on the other side of a door.
“I came home from work, and I came upstairs to see if my son wanted to play a game. I found that he had hung himself,” Bombeke said.
She immediately called 911 and worked to save her son’s life.
“It was 30 hours until he regained consciousness. It was the longest day of my life,” Bombeke said.
The day slowly turned into years of fighting for not only her son’s mental health care but its cost and coverage.
“I think consumers in the United States are aware that insurance companies, it might be challenging. We might be skeptical about how things will go. It’s worse than I could have ever imagined,” Bombeke said.
Her son, who InvestigateTV is not identifying, recovered from the physical aspects. For a year, she followed all the insurance guidelines took her son to inpatient and outpatient services. She was forced to learn how insurance works.
A year later, her son’s condition deteriorated again, and he ended up in the emergency room.
“Staying the course with the in-network cycle of emergency room, stepping down as quickly as you can, outpatient for as long as you can stand it, back to the emergency room and stepping down wasn’t going to keep him alive,” Bombeke said
She was trying to get coverage for different treatments, and the denials were piling up. She estimates she spent 1,000 hours filing claims and appeals and appeal of appeals: 3,000 pages of documents in the first few years.
“It didn’t seem to matter how good my appeal was, how compelling it was, how accurate it was, how clinically necessary the care was, how effective it was. I was going to be denied anyway,” Bombeke said.
In fact, a new government report shows therapists and other behavioral healthcare providers are having hours cut, and there is reduced staff and closed programs. Meaning some places were turning away patients during the pandemic as more Americans needed care.
According to data from the Centers for Disease Control and Prevention, during the first seven months of the pandemic, there were 26% more emergency room visits for suicide attempts, compared with the same period in 2019. The report notes longstanding questions about whether coverage or claims for behavioral health services are denied or delayed at higher rate than those for other health services.
That’s why Bombeke teamed up with Well Being Trust, a national foundation focusing on changing the way the nation is addressing mental health. Together they’ve created an 83-page guide to give families the tools they need to access their own benefits.
Ben Miller is a clinical psychologist now working as the chief strategy officer for Well Being Trust. He said the need for the guide speaks to the difficulty and barriers that exist in the health care system.
“It says a lot about our health care system. We know that most individuals seeking care for mental health are probably around six times more likely to pay out-of-pocket for those mental health services than they are medical services,” Miller said. “Carmen’s story is extremely compelling because I think she speaks to the struggle that so many families face daily.”
The guide weaves Bombeke’s struggle and advice all throughout, including her real experiences finding help for her son.
“I had to help other people because it’s just unfathomable to me that the treatment we were subjected to by our insurer is legal,” Bombeke said.
Bombeke was persistent and eventually got a denial for residential treatment for her son overturned. So he’s now covered for that treatment. She even went out of network, paying to send her son to a wilderness therapy program, a place where she said he thrived.
Today, he’s 18 and just wrapping up his freshman year of college.
“It’s just been so awesome to see him blossom into his own person and to see him be safe and productive. I feel thankful every single day,” Bombeke said.
The guide is publishing on the Well Being Trust website on June 21. It’s called Health Care Coverage for the Relentless, and it covers all the terminology insurance companies use and how to exhaust your appeals process.
If you or someone you know are in crisis, please reach out to the National Suicide Prevention Hotline at 1-800-273-TALK. You can also text HELLO to 741741.
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