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After seven years of treatment and multiple suicide attempts, Rachel Levasseur finally found a residential program that worked. But now her insurer, CareFirst BlueCross BlueShield, can’t decide if the treatment for obsessive compulsive disorder (OCD) is worth the money, a baffling and devastating blow for her entire family. As the family told NBC News, Levasseur’s case is just one of many examples showcasing the difficulty in securing quality, relevant and effective mental health care that is covered by insurance, particularly for complex cases.
Levasseur, 24, lives with a complex form of obsessive compulsive disorder which creates the conviction that she is a danger to others and contributes to an extreme fear of germs and illness. Her OCD is further compounded by autism spectrum disorder, which makes her black-and-white thinking harder to disrupt and irrational thoughts more challenging to recognize. Throughout the years, her condition grew so grave that her parents arranged to have her under their direct supervision nearly every moment.
“We basically took shifts where I would watch her through the day,” Levasseur’s father Larry said. “I’m a little bit heavier of a sleeper than Kandy [Levassseur’s mother], so she would take the night and we would have to check on her every few minutes to make sure she was OK and alive.”
Things changed last year when Levasseur’s parents reached out to a therapist at Sheppard Pratt, a Maryland psychiatric hospital whose self-pay, residential program, The Retreat, connects patients to a personalized care team of psychiatrists and therapists among other specialists. “When I got to The Retreat, it was different, because no one was giving up on me,” Levasseur said. “It just felt like much more of a place where people were very focused on me getting better, and I had a lot more of individualized support.” A year in, Levasseur’s wellness soared. She ceased all suicide attempts and became increasingly social, even willing to join a friend for dinner or a concert.
Though CareFirst covered just $521 of the out-of-network program’s staggering $3,000 daily price tag, her parents decided to pursue it anyhow, citing phone conversations with CareFirst representatives who told them their daughter was likely eligible for a “single case agreement.” If the patient can prove the care isn’t available to them anywhere else, CareFirst will allow patients to apply in-network benefits to an out-of-network provider.
There’s no better evidence than what’s right in front of them, Levasseur’s parents say. While other treatments addressed certain aspects of Levasseur’s mental health issues, the Sheppard Pratt program was the only one to target them collectively. “I truly believe that if Rachel wouldn’t have gone to The Retreat this last year, she would not be alive today,” Levasseur’s mother said. For now, though, CareFirst will not pay more than the fraction that it has.
Determined to keep their daughter in the treatment that’s saving her life, Levasseur’s parents have drained their retirement savings, taken out a second mortgage on their home, and now hold a hospital bill topping $1.3 million. Due to the outstanding debt, Levasseur has been removed from Sheppard Pratt’s specialized program and into its in-network general inpatient unit, where her mental health has noticeably deteriorated. This, despite an email last month from hospital vice president Bryan Mroz, stating that Sheppard Pratt “would be willing to enter into a single case agreement to address the current outstanding balance.”
“It’s just confusing how insurance can’t recognize that I am getting better finally,” Levasseur said. “They’re just focused on the money instead of my life.” More than that, she adds, CareFirst actually covering the program would cost less for everyone in the long run, including the insurance company, because she could simply get better and stop being in treatment.