The Herald, Sharon, Pa.

Community News Network

February 26, 2014

Does your insurance plan cover self-inflicted injuries?

— Dealing with a suicide or attempted suicide is stressful enough. Some health plans make the experience worse by refusing to cover medical costs for injuries that are related to suicide or an attempt - even though experts say that in many cases such exclusions aren't permitted under federal law.

When a 24-year-old woman with bipolar disorder attempted suicide last year by taking an overdose of an anti-anxiety medication, her mother assumed that her employer plan covering them both would pay the bills for her daughter's hospital care. But the insurer declined to pay the $6,600 charge, citing an exclusion for care related to suicide.

"I didn't think I had any grounds" to appeal the decision, said the mother, who lives in Fort Wayne, Ind., and did not want to be named. "I thought that's just the way it was."After negotiations with the hospital, the bill was reduced by half and her daughter has been paying off the balance in installments, the mother said.

"Suicide is a common exclusion," said Sara Rosenbaum, a professor of health policy at George Washington University. "Insurers are all over the place on this, and state law varies tremendously." In court cases arising from a denial of benefits, "if the suicide attempt is related to a diagnosis that was treated, typically [the courts] will not deny coverage," says Ann Doucette, a GWU research professor of evaluation and health policy.

Under 2006 rules implementing the federal Health Insurance Portability and Accountability Act (HIPAA), employment-based health plans can't deny eligibility for benefits or charge a person more because he has a particular medical condition such as diabetes or depression.

Insurers, however, are allowed to deny coverage for injuries caused by a specific activity or for those that arise from a particular cause that is spelled out in the policy. (These are called "source-of-injury" exclusions.) For example, an insurer that generally covers head injuries and broken bones could decide not to cover those injuries - and spell that out beforehand in the policy - if they're caused by risky recreational activities such as skydiving or bungee jumping. In a similar vein, insurers sometimes apply source-of-injury exclusions to refuse to cover injuries that are intentionally self-inflicted.

Mental health advocates and government experts point to the HIPAA rules, noting that source-of-injury exclusions aren't allowed if they're the result of a medical condition. So if someone is severely depressed or suffers from another mental illness and sustains injuries from a self-inflicted gunshot wound, for example, the health plan can't deny claims, these experts say, if the plan would generally cover the treatment for gunshot wounds that were not intentionally self-inflicted.

Further, the 2006 regulations "make clear that such source-of-injury exclusions cannot be imposed even if the mental health condition is not diagnosed before the injury," a Department of Labor spokesman said in an e-mail.

Roughly 38,000 people commit suicide annually, according to the National Institute of Mental Health. (For every suicide death, there are an estimated 11 attempted suicides.) And more than 90 percent of people who die by suicide have a mental health condition, said Jennifer Mathis, director of programs at the Judge David L. Bazelon Center for Mental Health Law.

While the HIPAA nondiscrimination rules apply to all employment-based health insurance, the new federal health law has extended those rules to the individual insurance market.

Some plans offered on the health insurance marketplaces contain source-of-injury clauses, said Carrie McLean, director of call centers at eHealth, which sells health insurance online.

Some exclude coverage of injuries related to suicide in all cases, while others make an exception for mental illness, she said.

Under the federal Mental Health Parity and Addiction Equity Act, health plans generally must provide mental health and substance use disorder benefits that are comparable to benefits for medical/surgical care. But if a plan denies coverage following a suicide or suicide attempt, it's probably not a parity issue because patients generally would require medical or surgical care to treat physical injuries rather than therapy or other mental health services. according to the Labor spokesman.

Questions about suicide exclusions in individual market plans should be directed to the state insurance offices or the federal Department of Health and Human Services, according to the Labor spokesman. Someone enrolled in a group plan may file an appeal with the health plan.

        

 

1
Text Only
Community News Network
  • Affirmative action ruling challenges colleges seeking diversity

    The U.S. Supreme Court's support of Michigan's ban on race-based affirmative action in university admissions may spur colleges to find new ways to achieve diversity without using racial preferences.

    April 23, 2014

  • A 'wearable robot' helps her walk again

    Science is about facts, numbers, laws and formulas. To be really good at it, you need to spend a lot of time in school. But science is also about something more: dreaming big and helping people.

    April 23, 2014

  • Cuba is running out of condoms

    The newest item on Cuba's list of dwindling commodities is condoms, which are now reportedly in short supply. In response, the Cuban government has approved the sale of expired condoms.

    April 23, 2014

  • The waffle taco's biggest enemy isn't McDonald's. It's consumer habits.

    Gesturing to Taco Bell, Thompson said McDonald's had "not seen an impact relative to the most recent competitor that entered the [breakfast] space," and that new competition would only make McDonald's pursue breakfast more aggressively.

    April 23, 2014

  • Screen Shot 2014-04-22 at 4.42.47 PM.png VIDEO: Leopard attacks crowd in India

    A leopard caused panic in the city of Chandrapur when it sprung from the roof of a house and charged at rescue workers.

    April 22, 2014 1 Photo

  • The top 12 government programs ever

    Which federal programs and policies succeed in being cost-effective and targeting those who need them most? These two tests are obvious: After all, why would we spend taxpayers' money on a program that isn't worth what it costs or helps those who do not need help?

    April 22, 2014

  • In cuffs... 'Warlock' in West Virginia accused of sexual assault

    Police in West Virginia say a man claiming to be a “warlock” used promises of magical spells to lure children into committing sexual acts with him.

    April 22, 2014 1 Photo

  • Cats outsmart the researchers

    I knew a lot had been written about dogs, and I assumed there must be at least a handful of studies on cats. But after weeks of scouring the scientific world for someone - anyone - who studied how cats think, all I was left with was this statement, laughed over the phone to me by one of the world's top animal cognition experts, a Hungarian scientist named Ádám Miklósi.

    April 22, 2014

  • McCain 1 House Republicans are more active on Twitter than Democrats

    Your representative in the House is almost certainly on Twitter. Your senator definitely is. But how are they using the social network? Are Democrats more active than Republicans, or vice versa? Who has the most followers on the Hill?

    April 22, 2014 1 Photo

  • Do your genes make you procrastinate?

    Procrastinators, in my experience, like nothing better than explaining away their procrastination: General busyness, fear of failure, and simple laziness are just a handful of the excuses and theories often tossed around. Now researchers from the University of Colorado Boulder have added another option to the list: genetics.

    April 21, 2014

  • Do White Castle prices tell us anything about the minimum wage?

    The paper looked at how many delicious steamed sliders the minimum wage has been able to purchase over time. The point is that as it notes, in 1981, the $3.35 minimum could buy a whole dozen. Today, at $7.25, it could purchase just 10.

    April 21, 2014

  • VIDEO: Moose charges snowmobile, flees after warning shot

    While snowmobiling in New England, Bob and Janis Powell of Maine were charged by a moose and caught the entire attack on camera.

    April 21, 2014

  • Can Hillary Clinton rock the cradle and the world?

    What's most interesting to contemplate is the effect becoming a grandmother will have on Hillary's ambition. It's one of life's unfairnesses that a woman's peak career years often coincide with her peak childbearing years.

    April 21, 2014

  • Smartphone kill switches are coming

    Smartphones need kill switches. It's a relatively easy solution to the pricey (and irritating) problem of smartphone theft. But who would have thought that the big carriers would team up with Apple, Google, Microsoft, Nokia, Samsung and lots of other manufacturers to voluntarily begin adding the technology by July 2015? The cooperative spirit! It makes so much sense!

    April 18, 2014

  • Why do wolves howl?

    Of all the myths that dog the wolf, none is more widely accepted than the idea that wolves howl at the moon. Images of wolves with their heads upturned, singing at the night sky, are as unquestioned as a goldfish's three-second memory or a dog's color-blindness (both also myths).

    April 18, 2014