After a North Carolina man attempted suicide twice, his wife tried to get him help at an inpatient clinic. But their insurance provider refused to cover the treatment, deeming it “not medically necessary.”
  • Payments Denied: After a North Carolina man attempted suicide twice, his wife sought coverage for his mental health treatment. His insurance carrier refused to pay for his care.
  • Third-Party Reviews: Patients can appeal denials and even ask for additional review by independent physicians. But less than 1 in 10,000 patients eligible for those reviews seek them.
  • Medical Necessity: Decisions made by those independent reviewers often turn on the issue of “medical necessity.” Reviewers’ decisions are binding and insurers must abide by them.