Why It’s So Hard To Get Mental Health Care | Patriot Act with Hasan Minhaj | Netflix

We're so glad to have you. Thank you again for recording this meditation for us, really. Oh, I'm happy to help. I love the app. Mental health is super important. Oh, absolutely, yeah. You know, anxiety disorders alone affect over 40 million Americans. -This is a crisis. -It is. It is. Now, you have your script. -Right here. -So do you want to just dive right in? Sure. Good.  Let's begin with a deep breath. In through your nose, out through your mouth. Release your concerns. Even the concern that the planet will be completely unlivable because of climate change. -Our decision-- -Okay, that's really good, but I would say try not to add anything, you know, 'cause we're trying to help people to actually manage their anxiety, not add to it. Sorry about that. It’s just sometimes I’m just…Arrrgh! No, totally, and it was good so... Hey, why don't you take a deep breath? Good. And exhale. Great, and let's dive back in. Yeah, sure. In this meditation, let's watch our thoughts come and go. Thoughts like, “Is a recession coming?”

-“What about global autocracy?” -Hasan. “What happens to the last .01% of germs that Purell doesn't kill?” Hasan, focus on the present moment. I'm sorry, I just didn't sleep last night. -I mean, that's normal. -You know what I'm gonna do? I'm just gonna lie down. Now? I'm gonna lie down. I'm lying down. Oh, my God. Hasan. Hasan? Hasan. Hasan. Hasan Minhaj. Anna Kendrick! Hey, sweetie. I'm just in the next studio over, and we can hear you whimpering about dictators and Purell. -I'm sorry, I-- -That's okay. You know what? I'm gonna send you my therapist's info. She's helped me out a ton. You think she takes my insurance? Oh, she takes every insurance. This is like a dream. I know. 'Cause it literally is a dream. Oh. Yeah, why else would I be talking to you? Right. Why would she be talking to me? Oh! Thank you! Thank you so much. I'm Hasan Minhaj. Welcome to Patriot Act. Thank you so much. We are back with our last episodes of the year and tonight, I want to talk about mental health.

You remember, from the movie Inside Out? And look, we gotta talk about mental health because... everyone is. Mental health issues matter. It's not something people care to talk about, but it's time to change that. It's like a sprained brain, like having a sprained ankle. I was recently diagnosed with Borderline Personality Disorder. Mental health is just as vital as our physical health. My anxiety, you know, I wear it every day. I feel like we're living in America, the anxious. Anxious? What's anxious? It's the word of the day. Anxious. Zach Braff looks like a 40-year-old orphan. And Telly looks like someone just added meth to a red velvet cake. Now, mental health is clearly having a moment, and a lot of people want to cash in. There are over 10,000 apps for mental health. And that alone gives me anxiety. Why would we turn to the apps? They're the reason why we feel so anxious. Like, imagine feeling insecure about your looks then your friend is like, “You know you should talk to about that? Idris Elba.” You’re like, “Luther? This isn’t helping me.”

Oddly enough, even Burger King is getting in on the action. Not everybody wakes up happy. ♪ When I'm feeling a little sappy, blah, or angry ♪ ♪ Just not happy ♪ ♪ All I ask is that you let me feel my way ♪ “The fast-food chain is rolling out a new line of real meals to reflect real moods.” “Pissed, Blue, Salty, I Don't Give a... oop! and Yaas!” I love the Yaas! Yaas meal! Yaas meal! -Yaas! -Yaas! “Yaas meal. For when you're feeling sassy.” And that is officially the moment “yaas” died. But you know things are bad when we're using mental illness to sell food. Pretty soon, Toucan Sam is gonna be like, “Hey, kids, I have PTSD from two tours in... Iraq!” That's so stupid. Look, mental health... has always been a huge issue, but it's finally starting to get the attention it deserves. And I know boomers are watching this like, “You Millennials are always complaining. Back in the '80s, we didn't talk about our feelings.

We were too busy paying $40 to go to college.” By the way, you also didn't talk about global warming, and now we have to deal with Al Gore. The point is we're all dealing with these mental health issues, or we know someone who is dealing with mental health issues. Last year, one in five American adults experienced a mental illness. Depression, anxiety, bipolar disorder. In one decade, teen depression rates are up 60%. And overall suicide rates have gone up almost 20%. And despite these numbers, there's still a big stigma around mental health, especially in the Asian community. You guys know how it is. Like, mental health isn't a thing for us. One time, I told my dad I was feeling sad, and he was like, “Drink water and pray.” And I was like, “What if that doesn't work?” and he's like, “Take a nap.” I used to not take my mental health seriously. I pushed it to the side for years because I was so focused on my career. I thought anxiety and panic attacks were totally normal. Like, I was like, “Look a constant state of panic will give me an edge. Like, if my heart feels like it's exploding,

that's how I know I'm alive.” But going to therapy was really helpful for me. Think about it, you get to talk to someone about your problems and not listen to theirs. It's like being a shitty friend. It's awesome. But I realize a lot of people can't do that because the deck is stacked against them. More than 43 million Americans suffer from depression, anxiety, or other mental health issues. But more than half never get help. Even people who have health insurance. And that is what I want to talk about tonight. Why it's so hard to get mental health care, even when you're lucky enough to have insurance, because chances are you are getting screwed over by your insurance company. Now look, insurers being the bad guy isn't surprising. It's like someone saying, “Hey, did you hear about James Franco?” You already know who the bad guy is. There's no Shyamalan twist on that one. But if you thought insurance was bad about regular health care, they're even worse about mental health care and that disparity is illegal because of a law called <i>The 2008 Mental Health Parity</i> and Addiction Equity Act, which was sponsored by former Congressman Patrick Kennedy. Now, you may recognize him as the only Kennedy you don't recognize.

No one writes books about Patrick. No one cares who he dates. But he's important to the story because he became a passionate advocate for mental health after suffering a personal tragedy. “Patrick Kennedy's tenure in the House was largely defined by personal struggles, including bipolar disorder and an addiction to painkillers, which he admitted to after crashing his car into a barricade outside the Capitol Building in 2006.” “It was then, in his darkest hour that Patrick Kennedy found his cause, he sponsored the Mental Health Parity Act.” See? Sometimes when you let a Kennedy drive, good things do happen. I'm just saying, maybe take the bus. That's all. This is a dark episode, I'm sorry. We're talking about mental health and depression. Look, the 2008 law updated an earlier law and covered mental health and addiction, since they often overlap. And it was a huge hit. It passed in the House with 89% and bipartisan support. Nothing is that popular on both sides of the aisle, except Grindr. Grindr has massive bipartisan support.

The 2008 law boils down to one key idea: parity. And I'll let Patrick elaborate. Mental health parity, requiring all health insurance plans to treat mental illness and addiction on the same grounds as other physical illnesses. You need to treat mental illness the same way. The same way. The same way! The same as every other illness! That's what the parity law says. “Same.” Same. Just want everyone to get it–same. That's his Kennedy quote. JFK was like, “Ask not what your country can do for you.” And Patrick was like, “Same! Just make it the same.” Also, for someone who wants everything to be the same, he never looks the same. I'm always like, “How can there be so many Kennedys?” But here I'm like, “How can this only be one Kennedy?” The 2008 Parity Law requires insurers to cover mental health the same... as physical health. That means insurers can't charge you higher co-pays for mental health care, they can't create separate deductibles,

and can't set a lower cap on mental health visits. They can't put stricter numeric or quantitative limits on mental health than physical health, and they often don't break those limits because the numbers make it obvious. It's kind of like how when you go to Whole Foods and someone goes in the ten items line with a full shopping cart, and you're like, “Ma'am, we see you, and you're violating federal law.” But insurance companies often break a different part of the law. Non-quantitative limits, which are any other barriers to mental health. And this is where they screw us over. For example, say you want to see a therapist, right? Your insurance provider is supposed to give you a list of therapists that they cover, but it's not that easy. Getting services through my plan, the hardest one by far is getting mental health services. Blue Shield sent me a list, like, I should be fine. Just make a few phone calls, I'll find somebody. I called everybody on this list. Only one place called me back. That's shocking. That woman, who's my age, actually made a phone call.

The last time I tried to make a phone call, I couldn't, because my dad was sending a fax. Fucking boomers. Am I right? Now, insurers... basically do nothing to make sure their directories are accurate. Sometimes their lists even include providers who are dead. They're like, “Oh, hey! Here's a list of dead people. Does that help your depression?” That's why they're called “ghost networks,” which sounds like a 24-hour News Channel of Patrick Swayze and Demi Moore having pottery foreplay, but it's actually even worse than that. In one study, researchers called 360 psychiatrists on Blue Cross Blue Shield's list. They could only contact and make appointments with 26% of them. And the other 74%, some of those phone numbers were for doctors who weren't taking new patients. Some didn't actually take Blue Cross, and some were totally random. One number was for a jewelry store. One was for a McDonald's. Imagine going to a McDonald's for therapy. You're like, “I wanna die.” And Ronald's like, “We can help.” Look, insurers shouldn't be making it harder to find a psychiatrist

because it's already really hard. In the United States, 51% of counties have zero psychiatrists. Last summer, Bloomberg News found that in the 400 miles between Billings and Bismarck, there is only one psychiatrist in that entire area. They're like, “Hey, Doc. Here's a sixth of the country, fix it.” That one doctor's name is Joan Dickson. I couldn't even believe it. So, you know, I gotta talk to her. Okay, screens. Call Dr. Dickson. Hello. Hey! Dr. Dickson, it's Hasan from Patriot Act. Now is it true you're the only psychiatrist for 400 miles? No, the local hospital hired another psychiatrist last month. Wow, okay. So... if I was there, I could hypothetically make an appointment with either of you. Well, not with me. I've got 1,800 patients so my practice is full, but I'd be happy to refer you to someone just a few hours from here. Fuck that. Screens, hang up. No! No one is driving seven hours for therapy. I want to feel better, but I'm not gonna pass fifteen Cracker Barrels to do it.

Now, even if you can get to a psychiatrist, 40% of them don't take any insurance, and on top of that, if you do somehow find a mental health provider who takes your insurance, good luck getting your insurance company to actually pay for your treatment because there's a good chance they'll stiff you by exploiting a concept known as “medical necessity.” So when your doctor recommends a treatment for you, your insurance doesn't just approve it. They hire their own doctor to review your doctor's recommendation to judge if it's “medically necessary.” Insurance companies are basically like, “Let's get a second opinion from ourselves.” Now, you can appeal this, but this review process is super subjective with lots of room for interpretation. And that can leave a lot of families on the hook. “Friedman and her spouse say their daughter needs intensive treatment for an eating disorder. Her doctors recommended full-time residential treatment. Blue Shield denied coverage, based on the company's own guidelines. A Blue Shield psychiatrist deemed that level of treatment not medically necessary.

The family paid $72,000. Blue Shield wouldn't pay.” What is with those Mario Party sound effects? It's like Blue Shield gets gold coins every time they do something shitty. Blue Shield denied coverage for the patient's OCD because they needed two more denials to buy the Genie's Lamp. Now they leveled up. Now, the insurance company was ultimately forced to pay for that girl's residential treatment, but only because the family appealed. Ultimately, “medical necessity” injects a huge conflict of interest for insurance companies because the more claims that they deny, the more profitable they are, which is why you can see sky high denial rates with mental health. Just look at a psychiatrist who worked for Anthem named Dr. Jack. “We found Dr. Jack's denial rate averaged 92% in one six-month period in 2011. We spoke to 26 psychiatrists from across the country, and everyone brought up Dr. Jack's name. Some called him Dr. Denial.” That is such a creepy photo.

He has resting “I-killed-my-wife-on-a-boat face.” Doesn't he? But also, a 92% denial rate is absurd. And a few of his co-workers had even higher denial rates. Some of them denied 100% of claims. Now, normally you only see that level of denial from NFL concussion specialists. They're like, “What? He can't remember the names of his first few children. That doesn't mean he can't play Sunday.” “Medical necessity” is also where you really start to see how mental health is treated way differently than physical health. Let me show you a case study. Ugh! Oh, God! That guy clearly needs medical attention and fertility treatments. But, depression isn't always as obvious as crushing your nuts. Anxiety doesn't show up on an x-ray, and insurance companies exploit that by saying mental health is more “subjective.” Now, compared to physical health care, insurance companies deny claims for mental health care twice as often. And that gray area is also why the bar for treatment can be ridiculously high.

“Brian Cada's 15-year-old daughter took her own life. A year and a half later, his younger daughter attempted suicide.” “She was unable to really process the death of her sister. She kept it inside.” “Residential treatment was denied. A less-intensive level of care was approved.” The hospital said, “What that translates to is your daughter has not failed often enough to get a longer-term treatment center.” So she has to have attempted suicide several times? Each time rolling the dice 'cause it might actually succeed? That's correct. United Health refused to give that girl the treatment she needed even after she tried to kill herself, saying that it wasn't “medically necessary.” Now if all of this feels like you're trapped inside of a disorienting maze of bureaucratic bullshit, you're right. It's made that way by design. Let's say this is the labyrinth of American mental health care. Here's what could happen to you, okay? You would ask your insurance for a list of doctors. Then you call someone who isn't taking new patients. Then you have to call someone who never gets back to you maybe because, oh, they're fucking dead!

Then you call another number and find out, wait a second, that's not a therapist, this is a McDonald's. So you talk to a fry guy named Keith. Now Keith, he's cool, but he's not a therapist, but he does have a lot of opinions about Bitcoin. Finally, you find a psychiatrist who's both alive and taking new patients. Great! But then they don't take your insurance so you have to pay $200 per session. Then you look up their office on Google Maps and you're like, “Oh, shit! It's 150 miles away.” So you get more depressed. Now you're crying. You get a prescription to help depression, but then your insurance company won't cover it because they say it isn't “medically necessary,” so you have to pay out of pocket, again! So you get even more depressed. Now you're really bawling so you go back to McDonald's and then you realize, “Oh, fuck! If I wanted real psychological help, I should have gone to Burger King. Yaas.” Now obviously, the Mental Health Parity Law isn't working and that might be because the government is doing a shit job of making insurance companies obey it. The agency most in charge of enforcing parity

is the Department of Labor. They're supposed to oversee five million insurance plans, but they only have 500 employees to do it. That means one person monitors 10,000 insurance plans. Look, I'm gonna be real. I have one insurance plan, and I can't keep track of it. Like, I'll go to CVS, they'll be like, “Who's your provider?” And I'm like... “Blue Geico.” Look, it's not just a lack of personnel, Congress has repeatedly added new laws and regulations to implement parity. But those regulations haven't given the government more power to enforce parity, and the results are exactly what you would expect. For the record, HHS and Labor, they have not issued a report on investigations, and they have not conducted any audits of insurance companies. Insurance companies are clearly in violation of the Parity Law. That's what this report says. These are giant gaping violations of the Parity Law. Giant gaping holes. This is definitely C-SPAN porn. Like, I imagine a buff dude walking in like,

“Hey, did someone order a roll call on the floor?” But... there is also a glimmer of hope. Across the country, people are so fed up, they are suing and winning. A federal court rules against United Health Group, saying that their insurance provider discriminated against patients with mental health disorders. “Patients were illegally denied benefits based on United Behavioral Health's internal guidelines. The federal court called the guidelines ‘flawed, unreasonable, and more restrictive than generally accepted standards of care’ and that financial incentives ‘infected the guideline development process.’” The court found that United Health blatantly put profits over providing proper mental health care. Meanwhile, insurance companies in Illinois and Indiana were both forced to settle for violating parity. And just last week, the state of Pennsylvania fined United Health for cheating patients with autism on their out-of-pocket cost. Autism! Next, we're gonna find out United helped convict the Central Park Five. Now look, enforcing parity won't fix everything,

but giving the Labor Department more resources and passing new laws that could actually hold insurers accountable, would be a big step in the right direction. In the meantime, there is something you can do to fight back, and it's the exact thing baby boomers tell you not to do... complain. Complain when your mental health coverage is denied. Be an asshole about it. Be like your mom on the phone with Delta. Just be like, “Representative! Representative, no hablas Español! I will not speak to a robot!” Because when patients do challenge denials, they often get reversed. A recent study found that when patients appeal, insurers end up reimbursing them, on average, 39% of the time. So if you've been denied mental health care, go to... It's actually run by Patrick Kennedy's foundation. Now, it might look different every time you visit it, but the point is complaining works, because everyone deserves strong mental health coverage, and I know Patrick Kennedy feels... the same.