Press-Republican

FYI...

March 2, 2014

Does your insurance plan cover self-inflicted injuries?

— Dealing with a suicide or attempted suicide is stressful enough. Some health plans make the experience worse by refusing to cover medical costs for injuries that are related to suicide or an attempt - even though experts say that in many cases such exclusions aren't permitted under federal law.

When a 24-year-old woman with bipolar disorder attempted suicide last year by taking an overdose of an anti-anxiety medication, her mother assumed that her employer plan covering them both would pay the bills for her daughter's hospital care. But the insurer declined to pay the $6,600 charge, citing an exclusion for care related to suicide.

"I didn't think I had any grounds" to appeal the decision, said the mother, who lives in Fort Wayne, Ind., and did not want to be named. "I thought that's just the way it was."After negotiations with the hospital, the bill was reduced by half and her daughter has been paying off the balance in installments, the mother said.

"Suicide is a common exclusion," said Sara Rosenbaum, a professor of health policy at George Washington University. "Insurers are all over the place on this, and state law varies tremendously." In court cases arising from a denial of benefits, "if the suicide attempt is related to a diagnosis that was treated, typically [the courts] will not deny coverage," says Ann Doucette, a GWU research professor of evaluation and health policy.

Under 2006 rules implementing the federal Health Insurance Portability and Accountability Act (HIPAA), employment-based health plans can't deny eligibility for benefits or charge a person more because he has a particular medical condition such as diabetes or depression.

Insurers, however, are allowed to deny coverage for injuries caused by a specific activity or for those that arise from a particular cause that is spelled out in the policy. (These are called "source-of-injury" exclusions.) For example, an insurer that generally covers head injuries and broken bones could decide not to cover those injuries - and spell that out beforehand in the policy - if they're caused by risky recreational activities such as skydiving or bungee jumping. In a similar vein, insurers sometimes apply source-of-injury exclusions to refuse to cover injuries that are intentionally self-inflicted.

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