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Her Mental Health Treatment Was Helping. That’s Why Insurance Cut Off Her Coverage.
(www.propublica.org)
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Only the criteria here was, "You have made progress." And "You are not a danger to yourself or others.". There is no condition about having to be at a point where you are no longer making progress, only that the person is no longer suicidal/homicidal at the current stage of progress. This isn't at all saying the patient wouldn't benefit from further therapy. That's not a condition for the "medical necessity" in this case. If your only criteria is that the person is somewhat improved and not in an emergency situation, then there is a high likelihood of regression upon cessation of medical intervention in any field of medicine. Hoping that they'll be able to get help again before they become suicidal/homicidal again is not a strategy and usually ends in tragedy. Most times they don't even bother to seek help. This case the person went to the ER, but often that's not going to happen if the person considers the cost of the Ambulance, ER, and hospitalization on top of the mental energy required to make the call and then explain your whole history to someone new and then justify your need for the services. It's unreasonable to expect a good outcome the more times the person has a bad outcome.