Reported by: Hagit Limor, I-Team
Photographed by: Anthony Mirones
Produced by: Phil Drechsler
9News Anchor (on set):
It's become a big worry for many of us: will we always be able to afford the health care we need?
And that includes people with insurance.
Now, one of the area's largest insurance companies has made the changes the I-Team's Hagit Limor discovered may make it tougher for some patients to get care.
Hagit Limor, I-Team Reporter (on set)
Especially for an illness experts say affects one in four of us at some time in our lives.
This is an issue that's flown under the radar, but has huge implications – so much that the Governor of Ohio sat down with the I-Team to express his personal outrage.
( ( I-Team BONG ) )
Gov. Ted Strickland (on tape):
"This is a very troubling set of circumstances that you are reporting on."
Hagit Limor, I-Team Reporter (voice-over)
What's troubling the newly-elected governor of Ohio has stunned local doctors:
Dr. Nancy Stella, CEO, Bridgepointe (on tape):
"There's no doubt about it. This will be a major hit."
Hagit Limor, I-Team Reporter (voice-over)
And blind-sided patients and their families.
Sue, Mother of mental health patient (on tape):
"I would say it's heartless."
Hagit Limor, I-Team Reporter (voice-over)
But the company at the center of this controversy isn't talking to the I-Team about it.
Hagit Limor, I-Team Reporter (on tape)
"I want to ask one more time if you'd do an interview with us."
Sue, Mother of mental health patient (on tape):
"This is probably about 15 months"
Hagit Limor, I-Team Reporter (voice-over)
She wants us to call her Sue, but her favorite name is Mom, happy to share fond family memories – playing on the beach, riding boats, dressing up for halloween – old photos that highlight how much the picture has changed in the last few years.
Sue, Mother of mental health patient (on tape):
"She's been hospitalized twice."
Hagit Limor, I-Team Reporter (voice-over)
Today Sue's 21-year-old daughter struggles with severe anxiety and depression, an illness tough to watch – harder to live.
Sue, Mother of mental health patient (on tape):
"The feeling of impending doom because you are so frightened."
Hagit Limor, I-Team Reporter (voice-over)
It all came to a head freshman year of college.
Sue, Mother of mental health patient (on tape):
"She ended up on quite a few medications and was barely able to function."
Hagit Limor, I-Team Reporter (voice-over)
Sue spent hours on the phone desperately trying to find help for her daughter – a doctor and therapist her Anthem insurance would cover.
Sue, Mother of mental health patient (on tape):
"So, everywhere I called I left my name and phone number. I didn't get calls back until six months later when there was an opening."
Hagit Limor, I-Team Reporter (voice-over)
Finally last year, Sue found a practice that could take her daughter.
Sue, Mother of mental health patient (on tape):
"This has been the best 15-month period of her last four years."
Hagit Limor, I-Team Reporter (on tape)
"How crucial to her life is the doctor right now?"
Sue, Mother of mental health patient (on tape):
"It's the most important thing right now."
Hagit Limor, I-Team Reporter (voice-over)
But now Sue's daughter could now lose the lifeline she's gained. Her doctor and therapist are cutting their ties with Anthem insurance.
The reason? In January, just after most of us picked our health plans for the year, Anthem decided to cut what it pays mental health therapists by a whopping 15-20%.
Now the biggest mental health practice in the area is dropping Anthem. Bridgepointe represents 2,500 Anthem patients, including Sue's daughter, who now have to search again for new therapists – or pay out of their own pockets for the ones they have.
Sue, Mother of mental health patient (on tape):
"To put a patient through having to start all over again, is just, I can't imagine what the insurance companies were thinking."
Dr. Nancy Stella, CEO, Bridgepointe (on tape):
"The best providers are leaving Anthem."
Hagit Limor, I-Team Reporter (voice-over)
Dr. Nancy Stella serves as president of Bridgepointe. She says her costs – utilities, salaries, insurance – only go up. So Anthem's severe cut meant she'd lose money on their patients.
Dr. Nancy Stella, CEO, Bridgepointe (on tape):
"With this rate decrease, we are unable to continue to treat these patients at such a low rate".
Dr. Theresa Lengerich, psychologist (on tape)
"I would feel deceived."
Hagit Limor, I-Team Reporter (voice-over)
Dr. Theresa Lengerich says patients who signed up with Anthem may not be getting what they expected. Her practice also quit Anthem, when it became about the lowest paying insurance she was accepting. Now, she gets at least eight calls a month, begging:
Dr. Theresa Lengerich, psychologist (on tape)
"'You're the tenth person I've called. Are you accepting Anthem? Can you please get my child in?,' and it's just really gut wrenching."
Hagit Limor, I-Team Reporter (voice-over)
Anthem wouldn't talk to us on camera, but in a statement it says its members continue to have access to behavioral health care and that the vast majority of its providers remain in network.
In fact, Anthem claimed in a recent newspaper article that, "95% of behavioral health providers ... are in Anthem network."
Dave Ranz, National Alliance on Mental Illness
"They clearly don't have 95% of mental health providers in the Greater Cincinnati community."
Hagit Limor, I-Team Reporter (voice-over)
Dave Ranz heads a local advocacy group for people with mental illness. His group polled local therapists and found only 40-50% actually take Anthem, and of those, some quietly are screening their calls.
Dave Ranz, National Alliance on Mental Illness
"Many of the psychologists and counselors and social workers are not taking new Anthem patients."
Hagit Limor, I-Team Reporter (voice-over)
And he wasn't the only one to say so. The I-Team heard from several sources who said even therapists, officially still with Anthem, really aren't accepting their patients.
Dave Ranz, National Alliance on Mental Illness
"That affects access to care for persons with Anthem insurance. And that is not acceptable and it is unconscionable because it puts profits ahead of quality treatment."
Hagit Limor, I-Team Reporter (voice-over)
Governor Ted Strickland is a licensed psychologist who's tried for years to get insurance companies to treat mental health care the same as physical health care.
Gov. Ted Strickland (on tape):
"I have talked very recently with my director of the Ohio Department of Insurance about this matter, and we are taking this seriously."
Hagit Limor, I-Team Reporter (voice-over)
Strickland says while he can't change Anthem's contract, he's asking the state's Department of Insurance and the Department of Health to look into Anthem's behavior.
Gov. Ted Strickland (on tape):
"We do have the right and the responsibility to make sure that if the company is claiming to provide a service – that they are not able to provide now because of a lack of professionals who are willing to participate – that is a serious, serious problem and that will lead us to take action."
Hagit Limor, I-Team Reporter (on tape)
"What do you think of the fact that the CEO of Wellpoint, which is the owner of Anthem, made $15.5 million in compensation last year while instituting a 20% cut for mental healthcare providers?"
Gov. Ted Strickland (on tape):
"My personal opinion is that it is outrageous. That it is simply outrageous. So much of our healthcare dollar is not going to healthcare – it is not going to provide healthcare to people who need it. It is going to administrative high salaries."
Sue, Mother of mental health patient (on tape):
"It is very frustrating to know that as a health insurance company, they don't seem to care about my daughter's health. It makes me very angry."
( ( I-Team BONG ) )
Hagit Limor, I-Team Reporter (on set)
Anthem told us – in the statement – that this is all for the good of the consumer: "To keep health care affordable," while allowing members' "access to quality health care when they need it."
Hagit Limor, I-Team Reporter (on set)
Keep in mind that 40-45% of employers in this area use some form of Anthem. Mental health advocates say employers need to look at exactly what they're buying before they sell it to their employees.
9News Anchor (on set):
What's the worst case scenario?
Hagit Limor, I-Team Reporter (on set)
Someone who needs medication doesn't get it, because they can't find a new psychiatrist who'll take Anthem.
But most people seek help for issues with jobs, divorce, death, school. They may have to suffer without care for at least a delay of time.
Anthem Insurance:
"We continue to keep health care affordable while making sure our members continue to have access to quality health care when they need it."
