On Sept. 24, 2019, Gina Moses received an unusual phone call from her teenage daughter. The girl was on vacation in Las Vegas and wanted her health insurance information.
When Moses asked why, everything tumbled out: The fight with her boyfriend, the suicide attempt and the trip to the emergency room. She called her mom from the hospital bed.
“She begged me to come get her,” Moses said. “She told me that she just wanted to come home.”
Moses lives in Albertville with her husband and two younger children. Within hours, she was on her way to Nevada.
“I stop and breathe and then pray for my daughter and for our family,” Moses wrote in a journal. “I pray for a safe trip to Vegas. I pray that I handle this in the right way to where it doesn’t affect the little ones.”
Moses and the teen spent the night in the same downtown Las Vegas hotel room where her daughter tried to take her life. When the boyfriend came back, the teen changed her mind about returning to Alabama.
“At that point, I realized just how delusional she was,” Moses said. “It was like she didn’t realize I had just flown all the way across the country to take her home.”
In Alabama, the daughter’s therapist said she would need residential treatment to learn how to subdue self-destructive thoughts. Under Moses’ insurance plan, the family’s out-of-pocket costs capped out at $875.
Then a problem emerged. Although the insurance plan covered residential mental health treatment, Blue Cross Blue Shield of Alabama wouldn’t approve payment for the types of private programs the girl’s therapist recommended.
Her issues mirror those of other insurance customers nationwide who struggle to get access to mental health benefits, in spite of two federal laws passed to make it easier to get coverage. Such challenges have persisted despite rising rates of suicide across the nation and in Alabama.
In Alabama, suicide is the second leading cause of death for people in their teens and early twenties, according to the Alabama Department of Public Health.
Alabama also has the nation’s smallest mental health workforce per capita, according to the United Health Foundation, and the least competitive insurance market. Blue Cross Blue Shield of Alabama covers nearly 3 million people, or 86 percent of the private insurance market in the state, according to the American Medical Association. That leaves Alabamians with few options for care and coverage of life-threatening mental illness.
“Do I think we would have had a second suicide attempt if we had been able to get residential treatment the first time around?” Moses asked. “No. She would have been there six months and she would have been over it.”
Guidelines and gatekeepers
Blue Cross Blue Shield of Alabama uses Kansas-based New Directions Behavioral Health to manage its mental health network and benefits.
New Directions acts as the gatekeeper for several Blue Cross plans, said Meiram Bendat, a California attorney involved in a lawsuit against the company.