Exposing the Hard Truths: Insurance Claims Denials for Substance Use Treatment, with Mark DeBofsky

ABOUT THE EPISODE:
Parents trying to navigate treatment with their kids are already pushed to their mental and emotional limits. When you're in it, you're so overwhelmed that it's hard to think about something as frustrating and time-consuming as insurance. But my guest today reminds us the earlier you get started and the more thorough your documentation, the more likely you are to receive coverage for the resources and services your child needs.

I contacted Mark DeBofsky before I even finished reading the first article I saw about his work. Finally, here was someone who could not only explain how insurance companies work in the context of mental health and substance use treatment, but also how you can increase the odds of receiving fair coverage.

Mark is the namesake and President of DeBofsky Law, which specializes in litigating denial of claims by large insurance companies and corporations. Over the course of this conversation, we cover a lot of ground related to the infuriating process of receiving coverage for treatment services. Among other things, we discuss:

• The confusing array of coverage guidelines used by companies and the courts
• The industry of physicians contracted by insurance companies to back up their denials
• What parts of treatment you should expect to get covered by insurance
• How A.I. is being used to both support and deny claims
• Why fewer than 2% of claim denials are appealed
• What steps you can take to set your family up for the best possible level of coverage

EPISODE RESOURCES:

• https://www.debofsky.com/
• NPR Medical Bill of the Month
• ProPublica article - Uncovered: How the Insurance Industry Denies Coverage to Patients
• Kennedy Forum for Mental Health Parity
• Wilderness Therapy Ruling May Deter Broad Policy Exclusions

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