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An Inspiring Advocate for Therapists with Joe Feldman · The Trauma Therapist

• 0:00
  Speaker 1: Welcome to the Trauma Favers podcast. My name is Ga McPherson.
• 0:04
  Speaker 1: I interview incredible people who dedicated their lives to helping
• 0:07
  Speaker 1: those who've been impacted by trauma. Here we go five four, three,
• 0:13
  Speaker 1: two and one, our folks, Welcome back to the podcast.
• 0:16
  Speaker 1: Very excited to have my guest today.
• 0:18
  Speaker 2: Joe.
• 0:19
  Speaker 1: Joe welcome, Thanks for having me here. Oh, you are welcome.
• 0:24
  Speaker 1: So Joe Feldman founded Cover My Mental Health. He began
• 0:28
  Speaker 1: advocating for access to mental health care after overcoming denials
• 0:31
  Speaker 1: for a family member's care, including with a successful federal lawsuit.
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  Speaker 1: His advocacy work has included policy driven discussions with legislators
• 0:40
  Speaker 1: and regulators, a board role with Kennedy Form Illinois, presentations
• 0:45
  Speaker 1: to parent groups, and publication of actionable guidance, such as
• 0:48
  Speaker 1: a twenty twenty one article in the Journal of Psychiatric
• 0:51
  Speaker 1: Practice on medical necessity letters. Joe welcome. I'm excited to
• 0:57
  Speaker 1: get into this. Before we do anything, share with the
• 1:00
  Speaker 1: listeners where from originally and where you are currently. So.
• 1:04
  Speaker 3: I was born and raised in Cincinnati, Ohio, and went
• 1:07
  Speaker 3: to college in Philadelphia and then moved to Chicago and
• 1:11
  Speaker 3: have been here pretty much ever since then.
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  Speaker 1: College in Philly. I spent some time in Philly, and
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  Speaker 1: I hear a little bit of the accent would where
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  Speaker 1: in Philly.
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  Speaker 2: I was at the University of Pennsylvania.
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  Speaker 1: Oh nice, awesome, All right, how did this start for you?
• 1:29
  Speaker 1: So how did all of this start for you?
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  Speaker 3: So this started when our daughter needed residential care back
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  Speaker 3: in her early high school days. We were just not
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  Speaker 3: succeeding with the with breaking through with some challenges that
• 1:43
  Speaker 3: she had, and my wife and I, on the advice
• 1:46
  Speaker 3: of her psychiatrist, got her that care. And not long
• 1:51
  Speaker 3: after she arrived in residential care, we got a call
• 1:54
  Speaker 3: from her therapist and she said, I'm going to get
• 1:58
  Speaker 3: a call today from who works for your insurance company,
• 2:02
  Speaker 3: and he's going to say we're done. We're not going
• 2:05
  Speaker 3: to pay for this. And I was confused, to say
• 2:09
  Speaker 3: the least that she knew this was coming. And she
• 2:11
  Speaker 3: called me back an hour or so later and said, yep,
• 2:14
  Speaker 3: he said denied, not medically necessary. Oh and so that
• 2:20
  Speaker 3: started my fighting back, and as you mentioned in the opening,
• 2:27
  Speaker 3: we eventually sued our insurance company in federal court and
• 2:32
  Speaker 3: won a judgment, which is to say, they were wrong,
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  Speaker 3: the care was medically necessary and they paid the claim
• 2:37
  Speaker 3: that they should have paid in the first place.
• 2:40
  Speaker 1: Well, what did you Let's go back a second here.
• 2:42
  Speaker 1: So your daughter goes to this treatment program. How long
• 2:47
  Speaker 1: had she been in it before you found out that
• 2:50
  Speaker 1: it wasn't going to be covered? Just a few weeks, okay.
• 2:54
  Speaker 1: And once you found out it wasn't going to be covered,
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  Speaker 1: what did you do specifically?
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  Speaker 3: Well, so we I had been i'll say, tipped off
• 3:04
  Speaker 3: by a friend of mine who had been i'll say
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  Speaker 3: down this path some years earlier with his daughter.
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  Speaker 2: And so I was i'll say.
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  Speaker 3: Shocked, but still I had I had the sense that
• 3:17
  Speaker 3: something was coming. So so two things happened. First of all,
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  Speaker 3: I continued to focus attention, along with my wife on
• 3:25
  Speaker 3: our daughter's care to make sure that she was getting
• 3:28
  Speaker 3: access to the care she needed. So we had the
• 3:31
  Speaker 3: i'll say the savings that we could dip into and
• 3:34
  Speaker 3: deal with the insurance company later. And I started to
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  Speaker 3: document everything that the insurance company was telling me, everything
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  Speaker 3: they were telling the program, and slowly i'll say, accumulating
• 3:48
  Speaker 3: the information that they were that they were using to
• 3:52
  Speaker 3: stand in the way of care. And it just didn't
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  Speaker 3: hold water. It was it was an obstacle that they raised.
• 3:59
  Speaker 3: I think on the assumption that we were going to
• 4:02
  Speaker 3: just say, okay, I guess that's too bad.
• 4:06
  Speaker 1: Like probably so many people do because they don't have
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  Speaker 1: the stamina, they don't know where to start, and they
• 4:12
  Speaker 1: don't have the resources, all the financial otherwise.
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  Speaker 2: All the above. I mean, it's yeah, I would say.
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  Speaker 3: In my in my professional career, I've had different responsibilities
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  Speaker 3: that required a level of i'll say project management, and
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  Speaker 3: that when I when I think about project management, I
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  Speaker 3: think about sequencing and putting, putting things in the right order,
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  Speaker 3: and where to go first, and who to who to
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  Speaker 3: talk to next.
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  Speaker 2: And all those skills.
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  Speaker 3: I had no idea we're going to be so useful
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  Speaker 3: in dealing with an insurance company standing in the way.
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  Speaker 1: So when this first started, you had insurance and you
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  Speaker 1: why did you think it was going to be covered?
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  Speaker 1: Let me ask that question.
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  Speaker 3: Well, I'd say initially I thought I was going to
• 5:00
  Speaker 3: be covered, because that's what health insurance is supposed to do.
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  Speaker 3: It's supposed to cover. It's supposed to cover your healthcare.
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  Speaker 3: Then at a certain point I got a copy of
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  Speaker 3: the entire insurance policy. So that's not just the three
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  Speaker 3: or four summary pages that you get when you when
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  Speaker 3: you sign up. It's in our case, it was I
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  Speaker 3: think two or three hundred pages of detail, and that
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  Speaker 3: detail said we will cover care that is medically necessary.
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  Speaker 3: And so I thought, okay, well this is medically necessary.
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  Speaker 3: They got it wrong, so they should cover it.
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  Speaker 1: So how did you determine and show them that it
• 5:40
  Speaker 1: was medically necessary? What did you need to do?
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  Speaker 3: So so I started off thinking, okay, what does this
• 5:51
  Speaker 3: i'll say argument, or what does this this debate look like?
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  Speaker 3: And I had the help of someone who is expert
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  Speaker 3: in filing an appeal, which is the path that we
• 6:01
  Speaker 3: started down. I would be quick to say that in
• 6:05
  Speaker 3: the meantime, I've learned of many different steps that you
• 6:07
  Speaker 3: can take before an appeal, but that I didn't know
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  Speaker 3: those things that I was focusing on an appeal and
• 6:14
  Speaker 3: I was getting help putting this packet together, and as
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  Speaker 3: I looked it over, I thought, there's something missing. And
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  Speaker 3: what's missing is the voice of our daughter's psychiatrist and
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  Speaker 3: the voice of the therapist on site who's helping to
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  Speaker 3: take care of her. And so with that, I'll say observation.
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  Speaker 3: I reached back out to her psychiatrist who'd help us
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  Speaker 3: make the decision about the residential care. And I said,
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  Speaker 3: I'd like you to provide a letter that describes why
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  Speaker 3: she's where she needs to be. And he said, okay,
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  Speaker 3: i'll do that. What do I need to put in it?
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  Speaker 3: So I said, I'll draft it for you and then
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  Speaker 3: i'll send it back.
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  Speaker 2: So I did.
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  Speaker 3: I prepared a letter. What I didn't know really at
• 7:02
  Speaker 3: the time is that that is a specific kind of
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  Speaker 3: document that clinicians can use, and it's called a medical
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  Speaker 3: necessity letter. So I created one, not knowing that it
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  Speaker 3: was a thing, but I could see that it was
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  Speaker 3: part of the missing i'll say argumentation. And so I
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  Speaker 3: had that document, and I had another document from the
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  Speaker 3: folks involved in her care on site, and that was
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  Speaker 3: the i'll say evidence that I could present in the
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  Speaker 3: appeal that indeed her care was medically necessary and therefore
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  Speaker 3: it should be covered.
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  Speaker 1: Which is is odd to me that it wasn't even
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  Speaker 1: asked for initially.
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  Speaker 3: Well, so that's exactly right. So insurance companies don't ask
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  Speaker 3: for a medical necessity letter in the same way that
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  Speaker 3: the process for resolving a dispute is i'll say incomplete.
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  Speaker 3: They tell you if you don't like what we're doing,
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  Speaker 3: file appeal. They don't tell you that there are other
• 8:02
  Speaker 3: steps that you can take. They don't tell you that
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  Speaker 3: a medical necessity letter might be helpful. That's something that
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  Speaker 3: we focus on quite a lot with Cover my Mental Health.
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  Speaker 3: It's a really significant way that clinicians, whether psychiatrists or
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  Speaker 3: psychotherapists or even frontline counselors, can help their help their
• 8:23
  Speaker 3: patients to establish that the care they're getting is in
• 8:27
  Speaker 3: fact what's required.
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  Speaker 1: All right, let's segue into that specifically. So how did
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  Speaker 1: you get to the point this is driving me not
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  Speaker 1: I can't imagine going through this. You know, it's not
• 8:39
  Speaker 1: just you're dealing with your your your phone bill and
• 8:44
  Speaker 1: people are giving you the run around. You're dealing with
• 8:47
  Speaker 1: your daughter's health and the seriousness and the gravity of
• 8:52
  Speaker 1: that and having to you know, be given the run around.
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  Speaker 1: How did you get to the point, Joe where you're like,
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  Speaker 1: I'm gonna, I gotta do something and you found it
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  Speaker 1: Cover mementtal Health, which is incredible. Right, So.
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  Speaker 3: We won this lawsuit that was i'll say remarkable. It
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  Speaker 3: took three years, and that's what got me involved with
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  Speaker 3: advocacy in the first place, and I joined the board
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  Speaker 3: of Kennedy Forum Illinois. I had a mutual friend introduced
• 9:22
  Speaker 3: me to Patrick Kennedy and I got involved there. I
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  Speaker 3: was still working my day job at the time and
• 9:29
  Speaker 3: so took an interest in this, I'll say as a
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  Speaker 3: part time way of giving back. I retired from my
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  Speaker 3: day job, which, by the way, my wife says, I'm
• 9:39
  Speaker 3: failing miserably at retirement. And at the very end of
• 9:45
  Speaker 3: twenty twenty three, I got a call from a friend
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  Speaker 3: of mine who is a psychiatrist and she runs a
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  Speaker 3: program here in suburban Chicago that serves primarily teens and
• 9:55
  Speaker 3: young adults. And she called me up to say, Hey,
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  Speaker 3: what are you hearing. She said, one of the big
• 10:01
  Speaker 3: insurance companies is talking about dropping coverage for telehealth. And
• 10:06
  Speaker 3: she said, because we learned during COVID that telehealth can
• 10:10
  Speaker 3: be a great compliment to in person care, and for
• 10:14
  Speaker 3: her population of patients, it's particularly useful. She said, if
• 10:18
  Speaker 3: they pull that coverage, it's going to be really, really
• 10:21
  Speaker 3: a problem. And she said, what have you heard, And
• 10:24
  Speaker 3: I said, well, I read something about it, but I'll
• 10:26
  Speaker 3: do some homework. So I called her back after a
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  Speaker 3: few days and I said, I found a letter that
• 10:32
  Speaker 3: was written to the head of this insurance company that
• 10:35
  Speaker 3: from all the big advocacy groups that said, you know,
• 10:37
  Speaker 3: to the head of ATINA, don't do this might be
• 10:40
  Speaker 3: illegal under the parody law. It might be a bad idea.
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  Speaker 3: You shouldn't do this. And so I said to her,
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  Speaker 3: you know, that's that's what those organizations should do. And
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  Speaker 3: at the same time, it's it's it maybe is not enough.
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  Speaker 3: And I said, do you have do you have families
• 10:55
  Speaker 3: or parents really who would write a letter to this,
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  Speaker 3: to the head of this insurance company them and say
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  Speaker 3: this is a this is a restriction that's going to
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  Speaker 3: hurt my family. And she said, yeah, I can think
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  Speaker 3: of a couple parents right away who who would do that.
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  Speaker 3: She said, you know, we'd have to we'd have to
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  Speaker 3: tell them what to put in the letter. And then
• 11:15
  Speaker 3: she paused, and then she said, actually, we would have
• 11:17
  Speaker 3: to write the letter. We would have to we would
• 11:20
  Speaker 3: have to make it as absolutely as easy for them
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  Speaker 3: as possible for them to help themselves. And that's that's
• 11:28
  Speaker 3: really when this light bulb went off for me, and
• 11:30
  Speaker 3: I thought, there are so many ways in which people
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  Speaker 3: can take steps to advocate for themselves, and when they're
• 11:39
  Speaker 3: in a crisis, the last thing they need is something
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  Speaker 3: like you know, the law is on your side. It's like,
• 11:46
  Speaker 3: no one cares if the laws on their side. They
• 11:48
  Speaker 3: want to know what do I do today? And so
• 11:51
  Speaker 3: that's when I had this thought, if we could develop
• 11:53
  Speaker 3: a resource that had downloadable template letters and scripts of
• 12:00
  Speaker 3: what to say to an insurance company rep and steps
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  Speaker 3: that you can take to deal with the dispute that
• 12:05
  Speaker 3: are beyond what you can find in an insurance policy,
• 12:09
  Speaker 3: that that could be really valuable to people who, as
• 12:14
  Speaker 3: you said, have got way more on their plate than
• 12:17
  Speaker 3: to take.
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  Speaker 2: On an insurance company.
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  Speaker 3: And that's what we was the origin of cover my
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  Speaker 3: Mental Health.
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  Speaker 1: Okay, so look at another way. Cover my mental health
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  Speaker 1: is for people who what aren't getting covered, can't get
• 12:33
  Speaker 1: covered for what.
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  Speaker 3: So our focus is on people who have private insurance
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  Speaker 3: and are facing an obstacle to that care. So it
• 12:45
  Speaker 3: could be they can't find a provider in their network,
• 12:48
  Speaker 3: it could be that they've been denied for not medically necessary,
• 12:52
  Speaker 3: or the telehealth sort of they i'll say, the origin
• 12:57
  Speaker 3: nudge that they're being told now you can't use tele health,
• 13:00
  Speaker 3: it's not available and we also, by the way, in
• 13:04
  Speaker 3: addition to providing resources to help patients and their families,
• 13:08
  Speaker 3: we also have resources that are specifically directed at clinicians
• 13:13
  Speaker 3: that help them in their interactions with insurance companies.
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  Speaker 1: Wow, okay, let's talk more about that. Give us some
• 13:25
  Speaker 1: specifics about that.
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  Speaker 3: Sure, as I talked about this idea of a medical
• 13:32
  Speaker 3: necessity letter is really it's a big idea. And so
• 13:38
  Speaker 3: a clinician who is taking care of a patient and
• 13:43
  Speaker 3: maybe it's i'll say office visit only, or maybe it's
• 13:46
  Speaker 3: intensive outpatient or or a higher level of care, maybe
• 13:49
  Speaker 3: it's in patient or residential, knows that an insurance company
• 13:54
  Speaker 3: is i'll say, going to call or has called to say,
• 14:01
  Speaker 3: why is this care necessary? Can't we do this on
• 14:04
  Speaker 3: some other basis? By the way, the other basis is
• 14:06
  Speaker 3: always a lower level of care. Why do you have
• 14:10
  Speaker 3: to use this medication?
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  Speaker 2: Why do you.
• 14:13
  Speaker 3: A psychiatrist was telling me a story just this week.
• 14:17
  Speaker 3: She said her patient was a teenager with bipolar disease,
• 14:22
  Speaker 3: and she said very clearly along acting injectable was the
• 14:27
  Speaker 3: way to go, and the insurance company just dragged their feet.
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  Speaker 3: So a medical necessity letter is a spectacular resource to
• 14:37
  Speaker 3: be able to document the training, the practice, and the
• 14:41
  Speaker 3: professional judgment of the clinician. And we offer a template
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  Speaker 3: that can be downloaded from our website. That template was
• 14:49
  Speaker 3: developed with input from litigators and appeals experts. Clinicians. I mean,
• 14:58
  Speaker 3: ultimately cover my Health is responsible for it. But it's
• 15:02
  Speaker 3: a downloadable template that has i'll say, the right prompts
• 15:06
  Speaker 3: and instructions to make it as absolutely easy as possible
• 15:10
  Speaker 3: for a clinician to make it their standard of care.
• 15:15
  Speaker 3: When you've got an insurance company denial sort of in
• 15:18
  Speaker 3: the waiting room, provide this letter to your patient so
• 15:24
  Speaker 3: they can have it to interact with their insurance company.
• 15:29
  Speaker 1: This is so interesting to me. First of all, I
• 15:32
  Speaker 1: just want to applaud you on what you've done. It's
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  Speaker 1: so friggin inspiring to meet someone like you who's like
• 15:40
  Speaker 1: going through this hell involving their daughter and like turning
• 15:45
  Speaker 1: it around and doing something. I think so many clinicians
• 15:50
  Speaker 1: and therapists need to know about this and have this
• 15:53
  Speaker 1: at their disposal. And I'm wondering if you're aware of
• 15:59
  Speaker 1: is this to I mean, I went to graduate school.
• 16:01
  Speaker 1: I don't remember learning about what to do in this
• 16:04
  Speaker 1: type of situation.
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  Speaker 3: Right right, So it's the last summer. I was having
• 16:10
  Speaker 3: dinner with the psychiatrist who runs a i'll say a
• 16:14
  Speaker 3: prominent psychiatric facility in the Northeast, and he what he
• 16:19
  Speaker 3: said to me was so interesting. He said, when we
• 16:23
  Speaker 3: go to medical school or we get our clinical training,
• 16:25
  Speaker 3: we're taught do no harm. We all know that the
• 16:29
  Speaker 3: Hippocratic Oath, and use safe and effective treatment, and use
• 16:33
  Speaker 3: general applied, generally accepted standards.
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  Speaker 2: Those all are familiar to us. He said.
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  Speaker 3: Nobody teaches us about medical necessity. He said, it's a
• 16:43
  Speaker 3: legal term. It's a legal term. And so if you're
• 16:47
  Speaker 3: in clinical practice, whether as a psychiatrist or or any
• 16:50
  Speaker 3: other level of care, they when the insurance company says
• 16:54
  Speaker 3: it's not medically necessary, that's that doesn't go back to
• 16:58
  Speaker 3: your training of late a second, what was the standard
• 17:01
  Speaker 3: of medical necessity? And so that's that's one of the
• 17:04
  Speaker 3: big I think opportunities is with with these medical necessity
• 17:11
  Speaker 3: letters to essentially close any gap that there might be
• 17:15
  Speaker 3: between an insurance company saying well, maybe that's not medically
• 17:19
  Speaker 3: necessary and the clinical training as applied, and to say
• 17:24
  Speaker 3: those two need to be the same. So that's that's
• 17:27
  Speaker 3: really the that's really the key.
• 17:30
  Speaker 1: How are you I mean like podcasts like this is
• 17:34
  Speaker 1: an answer, but how are you getting this out there?
• 17:36
  Speaker 1: How are people learning about this?
• 17:38
  Speaker 3: Sure? So we have I'll say three main ways that
• 17:43
  Speaker 3: we're trying to reach reach folks. Uh And certainly podcasts
• 17:47
  Speaker 3: and other other press and media are are important. Another
• 17:52
  Speaker 3: is reaching clinicians, either directly or through their associations. So
• 17:59
  Speaker 3: just this year, out of the opportunity to present the
• 18:01
  Speaker 3: resources of Covering my Mental Health at a practice here
• 18:06
  Speaker 3: in suburban Chicago that has twenty therapists and I could
• 18:09
  Speaker 3: talk to them, I presented in Cincinnati at the Linder
• 18:12
  Speaker 3: Center of Hope, which is a higher level of care.
• 18:15
  Speaker 3: Actually they have a full continuum of care, including inpatient
• 18:19
  Speaker 3: and I'll be in Houston next month to present at
• 18:22
  Speaker 3: the in February at the Meniger Clinic and another presentation
• 18:26
  Speaker 3: at ut Health. So that's one one way of getting
• 18:29
  Speaker 3: the word out.
• 18:30
  Speaker 2: And also.
• 18:32
  Speaker 3: Specialty publications are another opportunity to reach reach folks. And
• 18:38
  Speaker 3: I would encourage your listeners who have who are on
• 18:41
  Speaker 3: list serves to share That's another one.
• 18:45
  Speaker 1: When does this become necessary for clinicians Because I'm just
• 18:51
  Speaker 1: wondering for me, you know, having worked in clinics and
• 18:58
  Speaker 1: been involved with insurance and understanding that well, this isn't
• 19:05
  Speaker 1: gonna work, or this isn't gonna fly. They're not going
• 19:07
  Speaker 1: to do this, They're not gonna this is not going
• 19:08
  Speaker 1: to prove. I'm just thinking, ideally, you'd want therapists and
• 19:14
  Speaker 1: clinicians to have this at their disposal from the get go, right.
• 19:19
  Speaker 1: You don't want it to be at the eleventh hour
• 19:21
  Speaker 1: when they're scrambling for care in a sense, what thoughts
• 19:26
  Speaker 1: on that? Right?
• 19:28
  Speaker 3: So, so, I think our resources are especially relevant for
• 19:33
  Speaker 3: higher levels of care, either either when when a patient
• 19:37
  Speaker 3: is already in a higher level of care or when
• 19:40
  Speaker 3: it's the i'll say outpatient therapist or counselor or maybe
• 19:46
  Speaker 3: even a psychiatrist who's having an outpatient relationship says, you
• 19:52
  Speaker 3: know what, we need a higher level of care here.
• 19:54
  Speaker 3: That's that's an opportunity to say to the i'll say
• 19:58
  Speaker 3: receiving clinician, here's the patient, here's their file, happy to
• 20:04
  Speaker 3: be available to discuss it, so that you get the
• 20:06
  Speaker 3: full background and you can get a prior authorization if necessary.
• 20:10
  Speaker 3: And by the way, here's a medical necessity letter that
• 20:14
  Speaker 3: makes the hand the sort of clinical handoff around the
• 20:18
  Speaker 3: insurance coverage and removes any doubt about the referring clinicians
• 20:23
  Speaker 3: professional assessment.
• 20:27
  Speaker 1: And what are the what are the odds that that's
• 20:30
  Speaker 1: going to work? Do we do? You know?
• 20:33
  Speaker 3: Well, So, to be fair, there's no guarantee that uh,
• 20:39
  Speaker 3: that these tools are going to cause an insurance company
• 20:41
  Speaker 3: to to say, oh, I'm sorry, we got this totally wrong.
• 20:47
  Speaker 3: What I think we we can say is that we
• 20:49
  Speaker 3: are focused on.
• 20:51
  Speaker 2: Evening the playing field. And I think.
• 20:55
  Speaker 3: In in I'll say, in my experience and in talking
• 20:57
  Speaker 3: to clinicians when there when they're a level of i'll
• 21:02
  Speaker 3: say encouragement on the part of the clinician, and there's
• 21:06
  Speaker 3: information that is specific to the question, which the one
• 21:12
  Speaker 3: we've been talking about mostly has been medical necessity. The
• 21:16
  Speaker 3: chances are just vastly improved compared to, for example, advice
• 21:21
  Speaker 3: i've heard of you just have to be more aggressive
• 21:24
  Speaker 3: with the insurance company. And I've always thought, okay, so
• 21:27
  Speaker 3: I don't know how to teach be more aggressive with
• 21:30
  Speaker 3: an insurance company. It that sounds that sounds like, I
• 21:35
  Speaker 3: don't know, it sounds like a disaster. It sounds like
• 21:37
  Speaker 3: I don't even know what that what that means, and
• 21:40
  Speaker 3: so don't don't feel like you have to be more aggressive.
• 21:44
  Speaker 3: Just be specific and do do what you do, which
• 21:48
  Speaker 3: is make clinical assessments based on your training and your
• 21:51
  Speaker 3: application of standards, and then and then write it down
• 21:55
  Speaker 3: on a piece of.
• 21:55
  Speaker 1: Paper, right, and being equipped going into the discussion or
• 22:01
  Speaker 1: the the argument in the sense right right.
• 22:05
  Speaker 3: Yeah, So when when you have when there's a medical
• 22:09
  Speaker 3: necessity letter on file, and I know this not just
• 22:12
  Speaker 3: from our daughter's care, but later our son had some
• 22:17
  Speaker 3: challenges and inevitably we ended up with a denial. By
• 22:23
  Speaker 3: the way, even after a prior authorization, we had a
• 22:27
  Speaker 3: certain number of days approved for an intensive program that
• 22:31
  Speaker 3: he went to, and then the explanation of benefits came
• 22:34
  Speaker 3: back and said, no, just kidding, we're not going to
• 22:36
  Speaker 3: approve those days. After all, we're going to improve. We'll
• 22:39
  Speaker 3: approve seven of the twenty one that we previously said
• 22:42
  Speaker 3: were approved. So it's a little you know, it's a
• 22:46
  Speaker 3: little bit crazy, but having that having that letter makes
• 22:51
  Speaker 3: a difference.
• 22:52
  Speaker 2: And it's been.
• 22:55
  Speaker 3: My experience that insurance companies that say it's not medically
• 22:58
  Speaker 3: necessary now need to say compared to what so here's
• 23:04
  Speaker 3: here's the documentation of the of the clinician who's actually dealing.
• 23:08
  Speaker 2: With the patient.
• 23:09
  Speaker 3: And so you tell me what what did they get wrong?
• 23:13
  Speaker 3: That's a that's a totally different argument.
• 23:16
  Speaker 1: Right right. I love this. I just want to remind
• 23:18
  Speaker 1: your listeners of Seeking with Joe Feldman of Cover my
• 23:20
  Speaker 1: Mental Health. Love the name. It's like so clear of
• 23:24
  Speaker 1: what it is. So in addition to the we've been
• 23:28
  Speaker 1: talking about the necessity letter, what else do you offer?
• 23:31
  Speaker 1: What other kind of templates information do you offer on
• 23:33
  Speaker 1: your site?
• 23:34
  Speaker 2: Sure?
• 23:34
  Speaker 3: So, uh challenge finding a therapist that's who's in network
• 23:39
  Speaker 3: and available to you is another is another really significant barrier,
• 23:44
  Speaker 3: and this one's i'd say, can be even more challenging
• 23:48
  Speaker 3: because so many therapists and psychiatrists and psychotherapists don't take
• 23:54
  Speaker 3: insurance because reimbursement rates are not as good as they
• 23:58
  Speaker 3: should be and over site is a mess. And so
• 24:02
  Speaker 3: folks say, you know what, if I can take care
• 24:04
  Speaker 3: of people and have a perfectly good practice without insurance,
• 24:08
  Speaker 3: maybe that's just the way to go. But insurance companies
• 24:13
  Speaker 3: don't say, gee, we just can't find anyone. They have
• 24:15
  Speaker 3: their directories and the template that we offer for this
• 24:21
  Speaker 3: particular challenge is it's a worksheet and it's a way
• 24:26
  Speaker 3: to show that you did your homework. So if you
• 24:30
  Speaker 3: can imagine the conversation, you call up an insurance company
• 24:33
  Speaker 3: and say, hey, I can't get an appointment. I'm trying
• 24:35
  Speaker 3: to get in to see to see someone because I've
• 24:38
  Speaker 3: got really severe anxiety, and the insurance company says, well,
• 24:43
  Speaker 3: we've got a directory, you know, go figure it out.
• 24:47
  Speaker 3: So which is that's not hard to imagine, right, So
• 24:53
  Speaker 3: so the idea and at some level, I don't think
• 24:56
  Speaker 3: this is terribly surprising or profound.
• 25:00
  Speaker 2: It's just common sense.
• 25:01
  Speaker 1: Right.
• 25:01
  Speaker 3: So here's a worksheet where you can write down the
• 25:05
  Speaker 3: let's say it's five to a page, so fill out
• 25:08
  Speaker 3: a page.
• 25:09
  Speaker 2: Maybe you have two that.
• 25:10
  Speaker 3: Says I called first, I called this. I called Guy
• 25:14
  Speaker 3: McPherson and he didn't answer the phone. And then I
• 25:18
  Speaker 3: called Joe Feldman and he said, you know what, I'm
• 25:21
  Speaker 3: not taking new patients, or I never was in network.
• 25:24
  Speaker 3: I don't know why they've got me in their directory,
• 25:27
  Speaker 3: or I'll give you an appointment house November of twenty
• 25:29
  Speaker 3: twenty six, right, or you know, actually they're not where
• 25:34
  Speaker 3: they said the directory. Is they It turns out they're
• 25:37
  Speaker 3: an hour away, right. So the idea of the worksheet
• 25:41
  Speaker 3: is to be able to show your homework. Right, So
• 25:44
  Speaker 3: you say to the insurance company, I looked in your directory,
• 25:48
  Speaker 3: I did my homework. I can send this page to
• 25:50
  Speaker 3: you that documents I.
• 25:52
  Speaker 2: Did my homework. Now you do yours.
• 25:54
  Speaker 3: So get me an appointment with someone who's in network,
• 25:57
  Speaker 3: who's got the right expertise, sometime soon and someplace nearby.
• 26:03
  Speaker 2: Right.
• 26:04
  Speaker 3: Those are all just common sense expectations when you have insurance.
• 26:08
  Speaker 3: So that worksheet has been featured in a pro public
• 26:13
  Speaker 3: article on so called ghost networks, which is a term
• 26:17
  Speaker 3: that's used to describe networks that aren't really there. So
• 26:22
  Speaker 3: that's another another resource that we have on our site.
• 26:26
  Speaker 1: How did you come up with that?
• 26:30
  Speaker 2: You know?
• 26:30
  Speaker 3: I was I was talking with with someone who's involved
• 26:34
  Speaker 3: in mental health care advocacy about They call it network adequacy.
• 26:39
  Speaker 3: So is that network that is in the insurance directory
• 26:43
  Speaker 3: is it really adequate to meet the needs of their members?
• 26:47
  Speaker 3: And as we are talking about it, so I'll say reflexively,
• 26:53
  Speaker 3: I solve problems by thinking about a chart with rose
• 26:57
  Speaker 3: and columns. So people I work with tease me that like, Okay,
• 27:00
  Speaker 3: here's another here's another Rosen columns from Feldman, and I
• 27:05
  Speaker 3: thought this is a this is a case for a
• 27:08
  Speaker 3: row And column that says I called these therapists and
• 27:12
  Speaker 3: then I checked the box. They gave me an appointment,
• 27:16
  Speaker 3: they're not taking new patients whatever, or maybe you get
• 27:18
  Speaker 3: an appointment and you're you're good to go. So that's
• 27:22
  Speaker 3: it came about, just in a very sort of pragmatic way,
• 27:25
  Speaker 3: is like, show me your work.
• 27:29
  Speaker 1: All right, so awesome. I'm very excited to get this
• 27:34
  Speaker 1: out there. And I think, I don't think I know
• 27:38
  Speaker 1: a lot of therapists are gonna need this, and they
• 27:42
  Speaker 1: probably don't even know they do need it. So how
• 27:45
  Speaker 1: do people learn more about this and uh, find out
• 27:49
  Speaker 1: about what you're doing. That's the best way.
• 27:50
  Speaker 3: Sure, So covermymntalealth dot org is our website or a nonprofit.
• 27:58
  Speaker 3: You can email me directly at Joe at Covermimittalhealth dot com.
• 28:03
  Speaker 3: So my the email is dot com, the website is
• 28:05
  Speaker 3: dot org.
• 28:08
  Speaker 2: And those are.
• 28:09
  Speaker 3: The two the two best ways to h to reach me, Okay,
• 28:12
  Speaker 3: to reach reach our resources.
• 28:14
  Speaker 1: Okay, we'll have that linked up here also at the
• 28:17
  Speaker 1: show notes page at the Trauma Tapis podcast dot com. Joe,
• 28:20
  Speaker 1: Thanks man, just you know, we need people like you
• 28:24
  Speaker 1: who are advocating and uh and and doing it so
• 28:29
  Speaker 1: really inspiring.
• 28:30
  Speaker 2: Thanks so much.
• 28:31
  Speaker 3: And guy, thanks thanks a million for for giving me
• 28:34
  Speaker 3: this opportunity to uh to to spread the word and
• 28:36
  Speaker 3: as I said at the top, to give people encouragement
• 28:40
  Speaker 3: and then resources.
• 28:41
  Speaker 1: Yeah, all right, all right, we'll be in touch.
• 28:43
  Speaker 2: Take care. Thanks a lot, all right,