The Edmond Sun

Features

March 2, 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
Features
  • jc_Earp Marlin 2 - photo credit Noel Winters.jpg Shootout of a sale

    An original article of the Wild West will be made available at auction Thursday. The rifle of legendary lawman Wyatt Earp will be part of the J. Levine Auction & Appraisal’s Summer Quarterly Auction in Scottsdale, Ariz.
    Earp was an Arizona deputy sheriff and deputy town marshal in Tombstone, Ariz. He is legendary for playing a key role in the gunfight at the O.K. Corral. He died in 1929 at age 60.
    Wyatt Earp collector Barry Tapp of Edmond will be selling his 1895 Wyatt Earp Marlin rifle at the auction. The rifle has an estimated value between $50,000 and $75,000. It includes authentication documentation from Tombstone Heritage Museum, according to the auction house

    July 28, 2014 2 Photos

  • 11.6.12 Mother and Cub (2).jpg UCO forensic researcher answers key question

    After working a few human recovery cases on a volunteer basis with a variety of police departments, a question kept bugging Kama King.
    “You spend the whole day,” the UCO W. Roger Webb Forensic Science Institute student said, “sometimes days, searching for someone and only find a skull or a few bones and it just ate at me. Are we not finding this or is it not there to be found?”

    July 28, 2014 1 Photo

  • Karan & Rwanda.jpg Peace through Business empowering women entrepreneurs

    Peace Through Business is part of the Institute for Economic Empowerment of Women (IEEW) based in Oklahoma City. It is a program that connects small business entrepreneurs in Afghanistan and Rwanda with business owners in Oklahoma. One such entrepreneur found out about the program from a friend, applied, and was accepted to take part in this year’s session.
    Upon earning a master’s degree in Civil Engineering from the Universite de Sciences et Technique de Lille in Belgium, Lyliose Nduhungirehe began her career working for a construction company in Brussels, but she quickly switched paths to Information Technology.

    July 28, 2014 1 Photo

  • How to care for your pet without breaking the bank

    It’s a shame furry friends can’t pay for themselves. Though wagging tails after a long day at work may make pet ownership seem worthwhile, a happy pup won’t stop those bills from rolling in at the end of the month. Thankfully, quick and easy ways exist for dog owners to cut down on costs.

    July 28, 2014

  • MS_new pastor_Page_1.tiff Local church welcomes new pastor

    For one of Edmond’s newest pastors, faith and family intersect on a personal level.
    Sam Powers, pastor at Edmond 1st United Methodist Church, 305 E. Hurd St., and his family arrived in mid-May and his first Sunday in the pulpit was the second one in June. He and his wife Sheryl Heaton Powers, have two children — Kyla will be an eighth-grader at Cheyenne Middle School and David will be a fifth-grader at John Ross Elementary.

    July 28, 2014 1 Photo

  • pm_Ramona Paul.jpg Keith, 5 others to receive service awards

    The 2014 Door-Opener Awards Gala dinner and silent auction Sept. 4, benefitting ASTEC Charter Schools, will recognize five outstanding Oklahomans and one Kansan for lifetime contributions made toward helping others in society maximize potential and achieve dreams.
    Those selected to receive a Door-Opener Award at the Skirvin Hilton Hotel event include Dr. Harvey Dean, Pittsburg, Kan.; Toby Keith and Tricia Covel, Norman; Former Gov. George P. Nigh, Edmond; the late Dr. Ramona Paul, Edmond; and Natalie Shirley, Oklahoma City.

    July 28, 2014 2 Photos

  • MS_Andy Billups.jpg Local man relies on experience in July 4 emergency

    Andy Billups just happened to have gained experience as a combat zone firefighter/medic while he was serving as a civilian contractor in Iraq.
    The Edmond businessman just happened to have a friend with a place on Grand Lake where he has been viewing Independence Day fireworks for a number of years, and he just happened to be there July 4.
    And he just happened to be relaxing on a hammock when he heard a some kids making a commotion.
    Located two blocks east of Disney on State Highway 28 in the foothills of the Ozark Mountain Range in northeast Oklahoma, the 59,000-plus surface acre Grand Lake is known for its state parks, marinas, restaurants, motels and fishing.

    July 26, 2014 1 Photo

  • -1.jpg 5-year-old learns valuable lessons

    It is never too soon to learn about giving and receiving. An Edmond 5-year-old recently learned about both.
    Kendall Kingry will be entering kindergarten at Will Rogers Elementary this fall and she is already looking forward to November.
    “I get to go to Disneyland in November,” Kendall said.

    July 26, 2014 2 Photos

  • peach formatted.jpg Hard year for peaches doesn’t dampen summer tradition  

    A rusting, silver-colored water tower tells visitors to this rural town between Muskogee and Tulsa that they’ve come to the “Peach Capitol of Oklahoma.”
    Residents of Stratford, the state’s other self-proclaimed peach capital, might beg to differ. Even so, Porter is known for its peaches, and every year thousands of people flood this town of about 600 residents to taste and celebrate the local crop during the three-day Peach Festival.
    Like the aging water tower, Porter’s peach industry isn’t as vibrant as it once was.

    July 25, 2014 1 Photo

  • Final step to train toddler with baby on way

    Q: Using your advice, I successfully toilet-trained my daughter by age 16 months. It is now three months later and we are still using diapers at naps and nighttime. At her nap, which lasts several hours, she fully soaks her diaper. At night, she is taking off her diaper prior to falling asleep, wetting the bed after she goes to sleep and then crying for us when she wakes up in a pool of pee. Is this a sign that I should begin night training? I'm hesitant to do this because I am 8 months pregnant and don't relish the idea of waking up several times a night to take her to the bathroom and tending to a newborn as well. I would prefer to continue using diapers until she is old enough to get out of bed and take herself to the potty (even a potty in her room). Is this unrealistic? Or should I just deal with the extra night wakings and start taking her to the potty a few times a night now? If not, how do I keep her diaper on at night?

    July 25, 2014