The Practice of Therapy

Gordon Brewer: Well, hello everyone and welcome to the podcast again, and I'm really excited to be here. Really excited for you to get to know today, Joe Feldman and Joe and I have had a little bit of a conversation, but I think you're going to find him just fascinating, particularly the advocacy work that he's doing around mental health.
So Joe, as I start with everyone, tell folks a little bit more about yourself and how you've landed where you've landed.
Joe Feldman: Well, thanks, Gordon. I really appreciate your invitation to, to. To talk with you today. So I got into this world of advocating for for mental health care access. Not on purpose. Some years ago, our daughter required some significant care, specifically residential care, and my wife and I working with her psychiatrist found a suitable program for her and she needed it.
Entered that program and I'll say she got the care that she needed from that from that experience. Not long into her time in residential care we were, I'll say, quite surprised to get a message from our insurance company that her care was not going to be covered, that it was not medically necessary.
And I had been tipped off by a friend of mine who worked in This in the health insurance world that this is a possibility, but I still was surprised. I just couldn't imagine that that that news would come from the health insurance company that I worked with for a long time and had, I'll say, grown accustomed to not worrying about.
So They were wrong. The care was medically necessary, and over the course of her treatment, my wife and I dipped into our savings and we we covered it ourselves and meanwhile documented how our insurance company was dealing with us how they identified a third party psychiatrist to opine on her daughter's situation how that third party psychiatrist didn't listen to her therapist and documented a description of her status that was just in completely incorrect.
And after we were unsuccessful with two appeals, we sued our health insurance company in federal court and we won a judgment and they paid what they should have paid for in the first place. So through that whole experience I became exposed to this world of health insurance companies standing in the way of mental health care and substance use care for that matter.
And it really, I'll say, struck a nerve for me in a way that that I had learned some things that were, I'll say, a little bit of luck and a little bit of who I happen to be talking to, who, people who had experience in this area that made it possible for me to be successful on behalf of our family.
What I also learned is that the vast majority of people have no such resources. In Chicago, we like to say, do you know a guy who knows a guy who can get something done? And that happened to work for me in this case. Most people don't, they don't have a guy who knows a guy who can help them figure it out.
And so I've, I have been involved in advocacy for about seven years helping I'd say particularly at the point of crisis, helping clinicians and family and patients Push back. And most recently, so at the very beginning of 2024, I launched a new nonprofit. Called cover my mental health, and that's what I'm totally focused on on now.
As my wife would say, I'm I'm failing my Retirement from my from my paid career And doing something that I'm just super passionate about.
Gordon Brewer: Well, it's a it's certainly not Some wonderful work from what I've read up on it and was looking at your website before we started Recording and I think I know Just being in the business for as long as I have, particularly being a insurance based practice, it's something we're coming up against more and more.
And it's it's really disconcerting. I mean, just thinking, you know, that They're particularly some of the tactics that are used by insurance companies to keep from having to pay a plain claim. And just even for me personally last year I had trouble with just a medical procedure for the same reason in that they were saying it wasn't medically necessary, even though it's something that my doctor wanted and felt like I needed to have.
And so, yeah, and so it was just I think it's probably seeing more and more that across the board.
Joe Feldman: Unfortunately, I think that's I think that's exactly right. That's exactly right. I think the notion of of medical necessity can be, I'll say, a little bit confounding to trained clinicians because medical necessity is not a medical term.
It's a legal term. And I had a conversation back in the summer with a psychiatrist who runs a a residential program. They offer a variety of levels of care from psychiatry down to frontline therapists, and he said, you know, in medical school, we're not taught about medical necessity. We're talking about safe and effective care, generally recognized standards and do no harm.
And those should intersect completely with medical necessity. It just doesn't always work that way. Yeah, yeah.
Gordon Brewer: Well, I know that one of the things and just looking at your website and just and I just want to say thank you, Joe, for putting the time into this because it's You know, there's so many, as we know, it's the many of the people that are listening who are clinicians have seen the heartache of people needing help, but just will keep themselves from getting the help they need because they can't get it paid for and yeah, so tell us about your website and the resources you've come up with and just kind of the work that you're doing now to help people.
Joe Feldman: So, the idea of Cover My Mental Health as an, as an online resource came out of a conversation I had with a friend of mine just a little over a year ago. She had, she runs a, a clinic and they do a lot of care through intensive outpatient and partial hospitalization. And she called to tell me that one of the insurance companies that was important to her patient base was gonna pull coverage for telehealth.
And through the, through the pandemic, many people found that telehealth could be a really effective way of accessing care. And it could be whether the only way or complimentary way. She was extremely concerned. And she said, you know, are you hearing anything about this? And I'd read about the news, but I hadn't looked into it at all.
I hadn't started the company yet, the nonprofit. And so I had a look and I found that a couple of the, actually several of the big advocacy organizations like the American Psychiatric Association and the American Psychological Association and the National Association of Behavioral Health and a number of others had sent a letter to the, to the CEO of this healthcare company to say, basically, don't do this.
There's no reason for you to change your policy about telehealth. It's really important. So I went back to my friend and told her about this letter. And I said, you know, I think it's great that this letter went out. I'm wondering though, do you have parents of patients of yours? Most of our patients are teenagers or young adults.
Do you have parents of patients who would write a letter to the CEO of this insurance company? And say, you are hurting my son or daughter and our family, and there's no reason for you to change our access by, by disqualifying telehealth. And, so she immediately said, yeah, I can think of a few right away who would send a letter like that.
She said, we'd have to tell them what to put in the letter. And then she said, actually, Joe, we'd have to write the letter for them. Because that's what's gonna cause them to to take action there. They're in crisis of some kind, and to give them one more task is just too much. And that's when this light bulb went off for me that having template letters and scripts and worksheets that can be immediately used when someone is facing an obstacle from a health insurance company.
That is a big idea. And so I, I did a little bit of market research. So in the course of my, I'll say salaried career, I did a lot of work with launching new businesses and new technologies. And so I had an idea of how to think about, you know, if I, if I have a value proposition, who are the customers and who are the competition and, and, you know, what does the marketplace look like?
And I had never run across anything like. this idea. So I did some homework and I talked to a number of the leaders in mental health care advocacy. And what I learned was no one's doing this. And a few people had thought about it. It had never been done. So I got to work. Putting the resource together a lot of my own expertise and experiences there.
I'd say most of what I've done is bring together the, the ideas and the competence of a whole range of litigators and appeals experts and clinicians, former insurance company executives. I'd say some marketing people to help think about. Straightforward communication and the idea is people will come to the website and they will, first of all, they'll be encouraged right on opening up the website, which is www cover my mental health dot org.
They'll immediately look at the website and think, I can do this. This looks, this looks like a website that's here to help me. So, no legal jargon, no, you know, three part question about who, you know, what regulatory agency governs the plan you're in, is it employer based, blah, blah, blah, none of that. We get right to a button for, for example, denied, not medically necessary, which is a very.
I'll say a too common a too commonly found obstacle. Another button is no in network provider. That's a huge issue that's getting an increasing amount of press. And then there are a couple of other buttons as well. And the idea is someone that comes to the website, sees those buttons on the homepage and by going to the to the next page, they will find resources that they can download And I like to say that we deliver two things encouragement and a resource you can use this afternoon.
So resources that people can get started with right away that are incredibly accessible.
Gordon Brewer: Yeah,
Joe Feldman: that's great. That's great.
Gordon Brewer: So typically what's, what's the process when say somebody is, I'm thinking about it maybe from the clinician standpoint, but also the, the patient standpoint of what's the process people generally should take if they are denied for, you know, non medical necessity or whatever.
Yeah. Sure. Sure.
Joe Feldman: So So I'll describe what I think of as best practice, and then I'll try to get, I'll say practical in terms of where you know, where folks might, might get started. So best practice I would describe as, and this is, this is based on conversations with, again, clinicians and litigators and appeals experts best practice is when, when a, an insurance concern is on the horizon.
So we, you may not even have had a denial. However, the thought is going through the mind of the therapist or perhaps the patient or their family that I wonder if insurance is going to cover this because it's, it's different. It's a, it's a higher level of care. It's a more intensive level of care. For example, moving from outpatient to intensive outpatient.
Or to partial hospitalization, or even from a, I'll say a general practice family doctor who, who is saying, you know, I really think you should go see someone about an eating disorder. That's an opportunity to, to provide the patient with a medical necessity letter that documents, A clinical decision that's been made and specifically a decision about what care is medically necessary.
And those letters can be provided at, I'll say at any change in level of care that may be a time of risk for an insurance company to say, well, maybe that's not necessary. Certainly when there's a denial for not medically necessary, that is, that is I'll say in obligatory time for considering a medical necessity letter to document the clinician's expertise and competence.
the standards they're applying in their decision making. Yeah.
Gordon Brewer: And so typically with that, what success have you seen with those kinds of letters for people?
Joe Feldman: Sure. So I'll say first from my own experience medical necessity letters matter and they've helped me and my family to in the case of care that our daughter needed when a federal lawsuit.
So I'm not suggesting at all that that lawsuits are, are a good way to go. In fact, I'd say they're a terrible way to go. It's it's a very time consuming process. We required care for for our son and we had a medical necessity letter and that denial of care also for not medically necessary has been partially overturned.
I'm still let's say that's a project that's not quite done yet. I think one of the one of the great stories that that I heard was from Michael Grote, who runs the Linder Center of Hope, which is a pretty intensive residential program outside of Cincinnati. His story is on our website, by the way. And he told me that that the he was, he had a patient with a need for residential care and the insurance company told him as the clinician and the family that there were no more approved days for for inpatient care.
And Michael told me the story about how he took the medical necessity template letter that was in an article that I wrote actually three years ago. And he went back and grabbed that template. The, the version that's on our website now is, I'll say, a new and improved version. It's been enhanced a little bit.
The guts of it are the same. So Michael said, I remember having read the article from summer of 2021. I pulled it out. I used that template letter and I wrote I used it to to, I'll say, fill in the details of this particular patient, and he said the insurance company stood down, the additional days were approved, and the course of residential care for this patient was approved and the claim was paid.
And that's, I've heard from from litigators that medical necessity letters have worked for them, either in litigation or to to accelerate a settlement. And I've also heard from former insurance company executives that a medical necessity letter is, I'll say two things. It's a document from the clinician that explains their decision making and their competence.
And it's also a pretty clear indication that the member, so the, the the family member who has the insurance policy isn't just some, somebody who's calling up and upset and is sort of pounding their fist on the table. There's someone that is, has leveled the playing field. And when the insurance company says it's not medically necessary and they don't tell you why.
And your document from your clinician says, I'm doctor, so I'm Dr. Feldman, so I'm not a doctor, but I'm Dr. Feldman. This is my training. This is my experience with this patient. These are the standards of care that I've applied to this particular case. And this is my clinical judgment about the medically necessary care.
That is, that levels the playing field with the insurance company about how a decision about medically necessary care should be made.
Gordon Brewer: Yeah. I'd say, you know, it's, it's interesting the way that the system is, is set up in that it seems that as you're kind of alluding to is that people, insurance companies are hoping maybe that if they deny the claim, nobody's going to go to the extra trouble to try to fight that.
And so that they, they end up not having to pay money out because of that. And
Joe Feldman: yeah, I'm going to go with, it's more than hope. It's a business practice. I'd say another story that really rang true for me. If another friend of mine, who's a I think a psychologist by training and he runs the behavioral health unit for one of the hot, one of the hospitals here in in Northeastern Illinois.
Yeah. And he told me about one of the psychiatrists who works on his team coming to him and saying, you know, this insurance company has just worn me out. I've tried to get the care approved and it's just not happening. And I, I, I just can't spend any more time on it. Notwithstanding the fact that it's the right, the right clinical decision.
I have to, I have other patients to take care of too. And and my friend said that he told his his colleague. So on the one hand I understand. And on the other hand, you will be a marked man. You will be known as a pushover and someone who will not sort of last long in a conversation about who's making the clinical calls here.
And so he said his, he, his colleague I'll say got his energy back up in his muster to go back and and push back on the insurance company about what care is or is not medically necessary.
Gordon Brewer: Right. Yeah, it's you know unfortunately I've had some run ins with the insurance companies, as I mentioned earlier with my, not only with my own, an own, an issue I had for myself, but My late wife, when she was getting treatment for cancer, cancer treatment and you know, all of the things that, that went through that, I remember one time she had had some extensive back surgery because of a fall and they were the insurance company wouldn't, wouldn't approve her going to a more intensive rehab.
They were just saying it wasn't, yeah, you know, They were looking for the cheapest way out, and I dare say if I had not pushed with that, she would not have gotten the type of care that she needed. I think they were looking at numbers, you know, her, you know, the fact that she had cancer and just all of the other things.
Issues, but I guess the thing that got to me was is that that's not an in that's not a decision for the insurance company That's a decision for her doctor and her family to make right what kind of care should be that she should be getting
Joe Feldman: Right, right. Yeah, I think let's say this health health care in our country is complicated I think that's a that's a pretty safe pretty safe statement and and I think the idea of You I'll say unlimited care for an indefinite period of time for everyone is, is also, that's not, that's not realistic.
That's also not what we're expecting. We're expecting our, I'll say basic needs are going to be met. And basic needs can be as simple as, I've got an issue on my skin and I need to go see a dermatologist and get, The right treatment and basic can also mean I have a complicated cancer and I need a very particular and maybe costly hospital stay and chemotherapy and radiation and and other care.
And that's what basic care is. That's not that's not heroic. That's just that's really I'll say that's how we should treat one another. Right? And I think that's yeah. Yeah, a friend of mine says, you know, we know better so we can do better. And I think there's there's a lot of wisdom in just applying common sense.
How would you, you know, look, there's a golden rule aspect to this, right? If you know, if, if your wife needed physical therapy associated with a back issue, that doesn't sound grabby, right? That sounds like you and she want to take care of. A really reasonable health issue, and you're not asking to be flown halfway across the country to get it.
You're talking about I'll say, you know, driving into town. That's not hard. I don't think that's I don't think that's a I don't think that should be a difficult decision. And you know, I'll say in a way that's that's part of the mindset that I've tried to keep front and center with the with the development of cover my mental health.
Is to make it is absolutely straightforward as possible to make it to make it as common sensible, common sensical as as I can that when you buy health insurance, your expectations are completely reasonable that there should be a network of clinicians available to you. You should be able to access them nearby and nearby can be it.
I'll say in the eye of the beholder. I don't really quibble with his nearby five miles. Which, you know, maybe in suburban Chicago is not a big deal, or in northeastern Tennessee is not a big deal. If you're in Manhattan, five miles might be an hour. So maybe that's not the right measure. But nearby is something we can, I think, wrap our minds around.
And soon is another concept. Soon is a reasonable expectation. And soon could be I really need help today and soon could be a couple weeks is just fine, but six months is not soon. Right? There's or or next year is not soon or. Can't find an appointment at all. That's not soon. So just the idea that your common sense expectations should be met.
That's what you buy insurance for. And, and here's some resources that you can use, including steps that you can take. That insurance companies might well respond to so no guarantees, but they might well respond to steps that are different from what they tell you in your insurance policy. And that's that's really what we're totally focused on.
Gordon Brewer: Right. Well, well, Joe, this is, this has been a great conversation and I've got to be respectful of your time, but tell folks again how they can get in touch with you
Joe Feldman: The website is www. covermymentalhealth. org. If you have questions, you can email me directly.
My email address is joe at covermymentalhealth. com. And certainly welcome inquiries about the website. Certainly welcome folks to to have a look into share the website. One of the things that's really important for us is to, I'll say spread the word. And so we really invite therapists and provider organizations to think about putting a link.
On their website that has cover my mental health. And at the bottom of our website is a link to what's called our collaboration tool kit. And that tool kit has really a whole smorgasbord of of resources that can be used to help spread the word. Like there's a text that could be used in a, say, a patient newsletter or logos or other images that could be put on a website and yeah.
Those are really valuable ways that I'll say that you can help us to help even more people and Gordon. I really appreciate your Your time and your, your questions. And you know, let's, let's go out and make sure people get access to the care they need.
Gordon Brewer: Absolutely.
Well, Joe, I hope to have you back on the podcast and hope you I wish a lot of success with this. And I know you've got my wheels turning and thinking about things In a very positive way. Great. Well, thanks again.