I-TEAM: A father out of options turns to us after insurance denies mental health care

Published: Oct. 8, 2020 at 6:22 PM EDT|Updated: Oct. 9, 2020 at 5:16 AM EDT
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AUGUSTA, Ga. (WRDW/WAGT) - A local father turned to the I-Team after he says his insurance company denied his daughter mental health treatment. We went to work and found an issue much bigger than this one case.

Newtown might not have been our town, but it could’ve been any town.

“And they show the picture of the kid,” William Heitzman said. “He looks crazy.”

Heitzman isn’t proud of that thought now or the judgment that followed once it was clear Adam Lanza struggled with mental illness.

“I was that person said, you know, ‘Why do these parents let their kids go to school like that? Why didn’t you get them help?’ and now I know, I know why. Because you just, you can’t get help,” Heitzman said.

He’s been fighting. As a lieutenant colonel in the Army, he’s fought overseas. His latest battle has been at home with an insurance company. We first sat down in July when he was working from home.

“My wife had got custody,” Heitzman said. “These are her half-sister’s children.”

Years after moving in, both girls are still unpacking baggage. These medical records the family gave the I-Team shed light on abuse and neglect, but we’re keeping their identities in the dark to protect them both — especially the one who seems to have the deepest scars.

“She’s convinced she can transform into a wolf, and she just carries on an entire conversation,” Heitzman said. “You would think someone else was in the house, there’s — there’s no one there.”

She’s been in four different residential programs — the last one just last year where she was for about 9 months, but lately, things have been getting worse.

“She has all these imaginary friends who are when you look up on the internet there’s like these creepy killer, blood wielding axes,” Heitzman said.

Of particular concern — eteled — or “delete” spelled backward. He’s part of an internet horror story — much like the character Slender Man. In 2014, two 12-year-olds stabbed their friend 19 times because one of them believed the fictional character would attack her family if she didn’t kill the girl. Amazingly, she survived. The others were placed in mental facilities.

“She’s even told my wife you know that wasn’t that wasn’t me that attacked you, that was eteled that attacked you,” Heitzman said.

This April, her psychiatrist and her therapist sent letters to the insurance company to recommend another stay in another facility. It was denied. The family was confident they’d win the appeal, but the day before they were scheduled to move her into a facility in Arkansas, they were denied again. The insurance company said it was “not medically necessary.”

“Hey, this isn’t really required this is just a convenience to the family,'” Heitzman said. “It’s actually the way the letter was worded, like it’s just a convenience to you, like we’re just going throw out a kid so we don’t have to deal with her.”

Without insurance, they can’t afford the care.

“As a result, we’ve seen fewer admissions and shorter stays for individuals in an attempt to reduce costs by the insurance companies,” said Dr. Vaile Wright from the American Psychological Association.

“And there’s not a lot of transparency in who’s making the decisions, or what criteria, they’re using to make those decisions so that’s really part of the issue,” Wright said.

You can see the denial letter cites an “external reviewer — who is a board-certified physician in psychiatry and adolescent psychiatry.”

It also doesn’t give any criteria — just saying it’s “compliant with policy and standard of care.”

Federal law says insurance companies have to offer the same level of care for mental health services as it does for all medical or surgical care. So if a company covers hospitalization for any illness, it has to also cover it for mental illness.

“There’s not a lot of enforcement of that parity for insurance companies, so unless someone holds them accountable can kind of get away with making these sorts of statements,” Wright said.

Unless you head to court — the I-Team found plenty of examples of lawsuits, but not every family can afford the money or the time.

“I will say that denials, insurance denials, are one the greatest challenges, I think, to behavioral health provision,” said Polly McKinney, advocacy director for Voices for Georgia Children.

McKinney was watching when the Georgia Department of Behavioral Health and Developmental Disabilities recently slashed $172 million from its budget.

“We struggled to get the services before COVID, and I’m concerned we’ll really struggle to get them now,” McKinney said.

Not just in Georgia, but in South Carolina, too.

This study puts almost every state in a severe shortage of child and adolescent psychiatrists.

We found Georgia listed as a state with one of the lowest rates of child and adolescent psychiatrists.

In the meantime, long-term in-patient mental health programs continue to close. Our area hasn’t had one since Augusta University Medical Center closed 3 South in 2018. University Hospital and Trinity got rid of their long term inpatient programs, too.

As a result, there are not enough doctors and not enough programs. The programs that do exist, they don’t have enough money.

“It is terrifying, and the parents are exhausted,” McKinney said.

Which is why this parent is speaking out. After our interview, things got even worse for Heitzman’s family without the care her doctors say she needed and she was hospitalized.

“Because she threatened to kill herself, she got that emergency, but that was only for a week,” Heitzman said.

Meanwhile, the I-Team kept asking questions.

“She said, hey, whoever that reporter was really through them for a loop,” Heitzman said.

And finally — some good news.

“They said, ‘Hey, we reconsidered, you’re now approved,’” Heitzman said.

That’s great, but it shouldn’t take a nosy reporter, and lots of emails and lots of questions because reporters can’t do this for everybody who gets denied. And not everybody wants to speak out about it, too, because it’s a difficult conversation to have.

“People are afraid, but it doesn’t reflect poorly on you,” Heitzman said. “There’s things that we can’t do. Love won’t fix every problem.”

But love can make you try everything — even reaching out to the I-Team as a last resort.

Heitzman says after the emergency hospitalization, she’s doing a lot better so they’re holding off on the treatment facility for now. Still, if they need to make that step, the approval is ready to go.

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