Employee benefits attorney: “Are some insurers rationing or denying reimbursement for trans teens needing mental health services?”

Benefits and ERISA attorney who led successful class action efforts for insured autism treatment looks at new wave of insurance claim denials

Media Contact: Barbara M. Fornasiero, EAFocus Communications; barbara@eafocus.com; 248.260.8466

Royal Oak, Mich.—November 16, 2022— National employee benefits and ERISA attorney J.J. Conway of Michigan-based J.J. Conway Law, who was involved in landmark litigation granting previously denied insurance coverage of specialized health services for children with autism, sees troubling trends among families pursuing denied mental health claims for teens seeking gender affirmation-related treatment.

“The world of employee benefits law has distinct trend lines among those seeking legal counsel. Five years ago, my practice was largely focused on reversing denied long-term disability claims. For the past 18 months, it’s shifted to youth and mental health, especially for extended residential care, and increasingly, for transgender or gender non-conforming teens,” Conway said.

Conway estimates that for every 10 calls he gets about denied insurance claims for teens seeking residential treatment for mental health, three of them are from families with teens whose mental health challenges are related to gender identity. A study from Kaiser Permanente notes that between 2006 and 2014, transgender and gender non-conforming children had three to 13 times the mental health conditions of their cisgender counterparts.

The challenges to teen mental health in general are well documented. In December 2021, the U.S. Surgeon General issued its Protecting Youth Mental Health: A Surgeon General Advisory. The report looked at several factors influencing the rise in adolescent and teenage mental health issues, from social media to the effects of the pandemic. Troublingly, the report noted a record 51% increase in attempted suicides in early 2021 for adolescent girls when compared with the same measuring period in 2019. The report also noted that one in three high school students and half of female students reported persistent feelings of sadness or hopelessness, an overall increase of 40% over the past decade.

Conway notes that transgender mental health treatment is an issue he’s hearing about from other employee benefit attorneys throughout the United States.

“Anecdotally, my employee benefits attorney colleagues and I are questioning if there’s a systemic but perhaps unwritten policy by some insurers to deny mental health treatment to teens needing support for gender affirmation,” Conway said. “These teens are not seeking surgery; rather, treatment to guide them through what can already be tough years for teens.”

The challenge of obtaining mental health coverage for teens, regardless of their particular issues, is well-known to Conway, having worked with dozens of families to help them obtain coverage or reimbursement for medical expenses for their teens who needed extended mental health treatment.

“The greatest challenge is getting coverage for inpatient treatment when a teen is experiencing a mental health crisis. When the mental health crisis stems from – or is exacerbated by – the teen’s gender identity, insurance companies appear to be throwing consideration of cultural norms into the equation, and kids and their families are suffering,” Conway said.

The diagnoses in question include depressive disorders, severe anxiety, substance abuse and self-harming behaviors.

“When I was representing families in national class action lawsuits that ultimately resulted in the law guaranteeing healthcare coverage for a variety of autism treatment services, I learned that some physicians recommended that families not include the autism diagnosis in patient files because it triggered non-payment of claims by insurers,” Conway said. “That was a very bad time, and I don’t want to see a repeat of that advice when it comes to using the term transgender in their child’s medical records. I don’t want the identification factor to be a red flag for denial of mental health claims for residential treatment.”

Inpatient treatment is often warranted in cases where teens are experiencing a mental health crisis, and most families simply cannot afford to pay for these treatments out-of-pocket, according to Conway.

“Families should not be forced to forgo desperately needed mental health treatment for their teens because of the cost – or fear of discrimination based on gender identity,” Conway said.

About J.J. Conway Law

J.J. Conway Law was founded by John Joseph (J.J.) Conway in 1999 to work with individuals seeking full access to the employee benefits they have earned. The firm has been involved with nationally significant employee benefit, disability and pension cases, including class action lawsuits for such landmark decisions as requiring Michigan private insurers to cover autism health treatments for children through age 18 and protecting the pension rights of City of Detroit employees, police and firefighters as well as Wayne County employees by holding their trustees accountable for investment decisions. The firm’s motto is Conquer Tomorrow® and is dedicated to making tomorrow easier for their clients across the United States. Learn more on the firm’s website.