Why Colorado Residents Deserve Fair Mental Health Care Standards: A Call to Action for the Governor

In spring 2023, my daughter faced severe mental health challenges. Her self-harm and risky behavior led her doctors to recommend a short-term residential treatment program. Sending her away was incredibly tough. As both her mother and a physician, I understood it was necessary for her survival.

But this decision brought a new nightmare: dealing with our health insurance. Our insurer refused to cover her inpatient treatment, only offering to pay for outpatient services, which covered only a fraction of the costs. Despite her medical team’s push for long-term care, the insurance company claimed she didn’t need it.

To get her the help she needed, we sent her to three more long-term residential programs, costing us over $350,000 out of pocket. We had to take out loans and a second mortgage to afford it. Sadly, our experience isn’t unique. Many families face similar struggles as insurance companies often limit mental health treatment despite policies that promise coverage.

Recently, lawmakers in Colorado introduced House Bill 1002, aimed at ensuring families receive the mental health care they pay for in their premiums. This legislation seeks to align insurance coverage for mental health with that of physical health, which often faces fewer hurdles. The bill is now waiting for Governor Jared Polis to sign it into law.

As someone familiar with insurance operations, I assumed we would get some reimbursement for my daughter’s treatment. We submitted around 1,500 pages of professional evaluations and data, yet our final appeal was rejected because they claimed there was not enough evidence of her being a danger to herself, despite her visible scars from self-harm.

Interestingly, during this time, my husband was diagnosed with tonsil cancer. His treatment required no lengthy approval process from our insurer. The contrast was stark: he faced a higher survival rate than my daughter, who was in a much more critical state. Insurance companies still treat mental health differently from physical health, which is illogical. Health is health, after all.

Despite these challenges, I feel fortunate to have commercial insurance, unlike many families who struggle to access necessary care. We had the means to help my daughter get back on track. She is now recovering well and thriving in her second semester at college.

Yet, many families in Colorado aren’t so lucky. Others fall into overwhelming medical debt or avoid treatment altogether, worsening their conditions. According to the Colorado Health Institute, over 1.1 million Coloradans have diagnosed mental health conditions. Alarmingly, only 25.4% of those with commercial insurance received proper specialty care.

This is unacceptable. No family should endure what we went through, unsure if their loved ones can receive the mental health treatment they need and deserve.

The proposed legislation is crucial. It aims to create clear standards for what "medical necessity" means, so that insurers and doctors align on what is needed based on established clinical evidence. It ensures that medically necessary behavioral health and substance use treatments prescribed by a doctor are genuinely covered by insurance.

With so many families struggling, it’s vital for the governor to sign this bill into law. It can prevent devastating medical bills and save lives in our community.

Dr. Mona Abaza, an ear, nose, and throat surgeon from Denver, knows firsthand the uphill battle many families face in accessing mental health care. It’s time for change.

For further insights on mental health care access in Colorado, you can visit this report: Inseparable 2023 Access Report.

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