We, the undersigned, call for immediate reform to address systemic barriers imposed by insurance providers that prevent access to timely and essential mental health care for vulnerable patients. These issues are disproportionately affecting those relying on Medicaid and Medicare, violating federal mandates, and compromising the quality of care provided to individuals with mental health needs.

The Problem

1. Denied Codes for Covered Services
   Insurance providers contracted under Medicaid and Medicare—including HMOs and PPOs—routinely deny claims and authorizations for services explicitly covered under these programs. Essential mental health services, such as psychosocial rehabilitation (PSR), case management, and individual therapy, are being unjustly denied, despite federal requirements under the Social Security Act.
2. Unreliable Online Portals
   Platforms like Availity, mandated for authorization requests, frequently experience downtime, lose clinical documentation, and fail to provide accurate status updates. These failures delay care for patients who urgently need support.
3. Unprofessional Phone Support
   Phone-based support is plagued by undertrained representatives, poor professionalism, and excessive wait times. Some representatives answer calls unprofessionally or allow lines to ring indefinitely, further compounding delays.

The Impact

Patients suffering from mental health conditions—such as depression, anxiety, and severe psychiatric disorders—are being denied timely and necessary care. These administrative hurdles exacerbate symptoms, increase hospitalization risks, and worsen quality of life for the most vulnerable populations. Meanwhile, healthcare providers are overburdened by repetitive administrative tasks, diverting precious time and resources away from patient care.

Violations of Federal Mandates

These practices violate Section 1902(a)(10)(A) and Section 1902(a)(30)(A) of the Social Security Act, which require Medicaid-contracted entities to provide timely and comprehensive medical assistance. By failing to authorize covered services and introducing barriers, insurance companies are denying patients their legal right to healthcare.

Our Demands

We demand immediate and meaningful action to address these issues:

1. Resolution of Denied Codes: Ensure all Medicaid- and Medicare-covered mental health services, including PSR, case management, and individual therapy, are approved and reimbursed without delay.
2. Reliable Online Platforms: Guarantee that platforms like Availity are consistently operational, secure, and able to handle clinical documentation efficiently.
3. Professional Phone Support: Train representatives to handle calls professionally, provide accurate information, and ensure no calls go unanswered.
4. Simplified Authorization Processes: Streamline authorization workflows to reduce delays and administrative burdens.
5. Compliance with Federal Mandates: Enforce adherence to the Social Security Act, ensuring all Medicaid- and Medicare-covered services are provided in a timely manner.

Why It Matters

Mental health care is a right, not a privilege. Administrative inefficiencies and unjust denials are denying patients access to the care they desperately need, violating federal law, and eroding trust in the healthcare system.

By signing this petition, we demand that insurance companies and regulatory agencies take immediate action to eliminate these barriers and ensure mental health services are accessible, timely, and compliant with federal standards.