The murder of UnitedHealthcare CEO Brian Thompson has revealed a simmering anger with the American healthcare system in the spotlight. William Brangham discussed more with Wendell Potter. He spent decades working for the health insurance company, Cigna, before leaving and dedicating his career to reform.
Just as an FYI, sometimes mental health gets special coverage. So I have one of those high deductible plans but a few therapist visits are 100% percent covered before normal insurance math kicks in. I’ve been told this is a fairly frequent feature of employer coverage for whatever reason.
This is true and mental health is a pain in the ass specifically because of it.
This is probably what’s called an EAP, employee assistance program. Basically your employer benefits provider provisions a few sessions paid in full. Great for you, kind of a pain in the ass for me. It’s more paperwork, the coding is weird, and the payments are lower (sometimes by a lot, like 40% lower). Not your fault at all obviously and entirely an insurance problem. Just another thing that makes working within this system an absolute nightmare.
However, sometimes this is called a “carve out”. This is different and less of a direct pain but causes so much confusion. This is where your works benefits provider decides that insurance company a charges too much for mental health coverage so they don’t purchase that portion and instead “carve it out” and replace it with insurance company b. This can result in you having specific copays for mental health even if you have high deductible (or even a separate deductible) because it’s essentially a secondary insurance (though technically it’s not considered as such and you would generally never even know the name of the company handling the carve out)
This is SUPER confusing for consumers because when you get your benefits package they hand you a card that says Aetna or Cigna or whatever. Then you see my psychologytoday profile and I advertise I’m in network with Aetna, Cigna, etc. great! we do a consultation, feels good, you send me your info, then I go “ooh, so sorry, turns out I don’t take your specific Aetna plan”. Because your Aetna plan takes mental health coverage and subcontracts it to another company who I have never paneled with.
Sometimes this is because I have never even heard of the company (paneling with an insurance co is weird, sometimes it takes a week, sometimes it takes 10 months), sometimes it’s because their reimbursement rates are a joke (one literally pays $24/hr which doesn’t even cover my overheads), etc. This isn’t entirely on the insurer though as it’s the employer that cuts coverage benefits to do this, although the insurer rising costs year after year is definitely a factor in why an employer would do that tbf