BOSTON (WWLP) - Trudy Avery of Sandwich says her 25-year-old son, Corey, was treated at mental health facilities for opiate addiction, but was denied coverage because Blue Cross Blue Shield decided the treatment was not "medically necessary."
"It was brought up during his request that if he wanted to receive the treatment he so desperately needed, he should break the law, then the state through the court system would give him the necessary treatment at no cost," said Avery.
Avery fought Blue Cross Blue Shield and eventually settled in court. Now she's asking lawmakers to advance a bill that would require health insurers to disclose what criteria they use to approve or deny coverage.
"We're allowing insurance companies, based on ‘secret' science, to tell doctors what procedures are medically necessary or not for their patients," said Dr. Karen Postal, president of the Massachusetts Neuropsychological Society.
But a Massachusetts health care overhaul bill signed by Governor Deval Patrick last year already requires insurers to disclose their coverage criteria. That provision goes into effect in 2015, and western Massachusetts lawmakers are waiting to hear all sides of the story before moving the date up.
"Take a look at the bill and hear both sides of the story and talk to insurance companies obviously to make sure you know if the timeline is something that could potentially be moved up," said Sen. James Welch (D-West Springfield).
Supporters of the bill insist it must be passed immediately to save lives. They say many addicts do not check themselves into mental health facilities because they are afraid of being denied or unsure of their coverage.