Overcoming Insurance Obstacles with Joe Feldman #76

I'll say on the network side, network inadequacy is just so. It's so insidious, right? You know, you pay for health insurance, the first expectation that you have that you don't even really think about is, well, they're going to have a network of providers. That's what they do, right? They provide a network. But that's just not the case. Networks are thin relative to need when it comes to mental health and substance use disorder.

Hello, I'm Dr. Farrah White.

And I'm Dr. Grant Brenner.

We're psychiatrists and therapists in private practice in New York. We started this podcast in 2019 to draw attention to a phenomenon called the Doorknob comment. Doorknob comments are important things we all say from time to time, just as we're leaving the office, sometimes literally hand on the doorknob.

Doorknob comments happen not only during therapy, but also in everyday life. The point is that sometimes we aren't sure how to express the deeply meaningful things we're feeling, thinking and experiencing. Maybe we're afraid to bring certain things out into the open or are on the fence about wanting to discuss them. Sometimes we know we've got something we're unsure about sharing and are keeping it to ourselves. And sometimes we surprise ourselves by what comes out. Welcome to the Doorknob comments podcast, Grant. I'm here with my co host, Farah, and today we're welcoming our special guest, Joe Feldman, founder of COVID My Mental Health, a not for profit devoted to helping patients and their families get proper coverage from insurance companies. Joe Feldman is Cover My Mental Health president and founder. He began advocating for access to mental health care after overcoming denials for his daughter's residential care, including with a successful federal lawsuit. Feldman developed Cover My Mental Health based on his own success overcoming insurance obstacles with input from leading litigators, appeals experts, clinicians, insurance regulators, and former insurance industry insiders. His advocacy work has included policy driven discussions with legislators and regulators, a board role with the Kennedy Forum, Illinois presentations to parent groups, and publication of actionable guidance such as a 2021 article in the Journal of Psychiatric Practice on medical necessity letters. Feldman also serves on the board of Thresholds, a Chicago based firm providing support to those living with mental illness, and Acadian Kitchens, a for profit seasonings business in Louisiana. Welcome Joe.

Thanks very much for, for hosting me, Grant and Farrah.

Yeah, thank you for being here for, for taking the time today. I would love to hear a little bit about how you and Grant cross paths. If it's okay. And you know a little bit about your story and, and motivation, where you felt certain turning points were. You know, any of that.

Sure. So. So Grant and I were introduced through a mutual friend, John Zollinger, who is one of the. The key executives at the Austin Riggs center in Stockbridge, Massachusetts. Austin Riggs is a. A leading private psychiatric facility. They take patients with, I'll say, more challenging cases, and they're led by Dr. Eric Plaikin, who is not only a psychiatrist and leader of this facility, but a really strong advocate for patient rights and patient access to care, particularly related to insurance company obstacles. So John and I have collaborated for a number of years, and he said, joe, you and Grant need to talk to each other. And we have. And John was right. It's been really great to meet Grant and to learn about his work and how it complements mine. I started cover my mental health, as I'll say a logical step, but not a planned step, related to some advocacy work that I'd been involved in for a number of years. As Grant mentioned in his very kind introduction, our daughter, during her early high school days, had some pretty significant challenges and needed, at the recommendation of her psychiatrist, some residential care. And my wife and I made sure she got that care. And by the way, she's doing well. She's 26 and has, I'll say, the problems of a 26 year old, as opposed to something more dramatic. Our insurance company, pretty shortly after she went into this program, said, we're not paying for this. It's not medically necessary. And so they were wrong. Also, as Grant mentioned, we eventually filed and won a federal lawsuit against this insurance company, and they paid what they should have paid for in the first place. Now that was years later, and I learned an awful lot through that process. One of the things I learned is that it's extremely difficult to pursue the reversal of an insurance company decision with litigation. It's just not a great option. It's not timely, it doesn't work for everyone. And I would say we had a really unique set of circumstances in terms of documentation and just really black and white unambiguous evidence of an insurance company behaving badly. As a result of that experience, I ended up, through another mutual friend, meeting Patrick Kennedy, who has been really a national hero around mental health care access. Patrick and I had lunch when he was in Chicago, and he invited me to learn a little bit more about what he and his colleagues were up to. And I, I joined the board of the Kennedy Forum, Illinois, and, and got involved in, I'll say, broad prop. Broad policy work there. But it was really as much as I like the policy side and I still have a chance to participate in policy discussions from time to time, I'm really drawn to support at what I call the point of crisis, which is when patients or their families or even clinicians hit a wall with an insurance company and they don't know what to do. As much as it's good to know that the law is on your side, federal law or state law, when you're in a crisis, that's just not helpful. What is helpful are resources that you can use today. And that's really what cover my mental health is about. It's resources that someone can use with the help of a clinician, perhaps like a medical necessity letter, or they can use themselves like a worksheet to document that they've looked for and failed to find an in network provider. Those are useful today. And that's, that's what really what we're all about.

What, what was your background in terms of your own work or personal experience that enabled you to stay the course? A lot of people understandably get deterred where they don't know how to move through a system like a litigation process or even appeals process. Is there anything that made it so that you were able to do this?

Well, I'd say so. Two things come to mind. One is during my professional career, I spent probably two thirds of it involved in starting new businesses and helping new businesses grow. And so that involved a lot of, I'll say, project management and sequencing. So a guy who I learned an awful lot from, a commercial attorney in California, he said, if you can think through the sequencing of a problem, you're probably about three quarters of the way done. And I think that that advice was really helpful. So. So I had a professional background that involved a lot of project management and sequencing. I also had the benefit of a friend tipping me off. Literally a week after our daughter left for her residential program, she said to me, you know, by the way, your insurance company is going to give you troubles. And I had not given that any thought at all. I had been totally focused on following the advice of her daughter's psychiatrist and finding the right program and helping with that transition. So immediately I was tipped off to the possibility that the insurance company was going to do something down the road that was not going to be helpful. And so that led me to, right from the start, document every single interaction I had with an insurance company customer service rep, or so called care advocate. And I treated. Although I'm not trained as a lawyer, I worked with lawyers so much through my professional career, I've been accused of at least thinking like a lawyer sometimes. And so I could treat every interaction I had with an insurance company customer service rep like I was deposing them. So I always asked for a badge number, for example, and very often they'd say, well, we don't give out badge numbers. And I'd say, okay, well, I actually know that you do, so why don't we wait, and then when you're ready to give me the badge number, then we can continue the conversation. And then they always gave the badge number because I wanted to be able to document exactly what was going on. That's. Those are really the two things that, That I think sort of laid the groundwork for all of this.

Yeah, I absolutely wondered if you were an attorney at some point, but I catch your drift.

I did take the LSAT once on a dare, but that's as far as I took it.

I think you are the first person that I've heard of doing this kind of work. And I'm sure, Grant, you run into this a lot trying to support your patients. I'm really, really happy that everything that you worked to do and change is out there in the form of a website that's readily available to people. And I know that as we were talking, you said that that's something that you want to build out. Do you feel like the word is getting out in an organized way? Because I have these discussions with patients weekly, whether their sessions are being denied or whether they need a higher level of care or a certain medication. I feel like I am constantly duking it out with insurance companies, and I'm not even in. In network with insurance companies.

Right. So. So the word is getting out. I would say slow, but sure. This is, I would say, in a way, a classic marketing challenge, which is there's a lot of people out there who would benefit from this information arriving at just the right moment when they're in a position to hear it and take a step to. To act upon it. So we're trying, I would say, in, in a lot of different ways, some creative, some just very pedestrian, to connect with providers, with advocacy groups, whether at a national level or at a regional level. Community based groups, you know, certainly I'll say opportunities like this, to share, share what we're up to will. Will help spread the word. It's, in a way, it's, you know, one way in which we, I'd say Maybe you're more challenged is that this is not, I'll say, an established market. So, you know, because of my commercial background, I, I think a lot about what's the market for this, what's the value proposition. I treat this very much as a, as a, I'll say, in a business with a business mindset and because we have no competition, meaning there isn't a resource out there like this that's already caught people's attention that we can say, hey, we're better. We have the issue of we're new. This is a service. These are resources that no one has offered before, amazingly. And so we have to first let people know that this is something that you may not have run across before and it's relevant and it's available today at no cost. And your patients or your family can use these resources right away.

Right. So listeners who are interested can also see Joe's interview on my Psychology Today blog, Experimentations, which posted a few days ago and was featured because it's so important for exactly the reason you're saying that consumers aren't aware of resources like this. So how do we get the word out? So encourage people to look up that blog and share it. I've shared it widely with my, you know, referral network listservs and colleagues.

Yeah, I do think it's important that people understand the information that's coming down from their insurance company and to also know that there are smart and dedicated people who are going to help them kind of get there, get the benefits that they should have. And so if we could talk a little bit about what you see most commonly. I know what I see in my practice, which is a lot of people who end up coming to me because they would like to use their insurance and have a copay, but they can't find someone with a sufficient level of training who can handle the complexity of their case in their network. And so we can sometimes do certain network equivalency exceptions. But I learned all of this kind of on the fly. One of the things that, and I know from your personal story but just in doing this work come up most frequently.

Right. So the, I'll say the, the hit parade of obstacles is. Are led by to denials for not medically necessary and the let's say obstacle of I can't find a provider in my network and they've been widely reported in I'll say healthcare press and also in the just national press because I'll say on the network side, network inadequacy is just so it's so insidious, right? So you get, you buy, you know, you pay for health insurance and the first expectation that you have that you don't even really think about is well, they're going to have a network of providers. So when I, when I need a provider, I'll be able to go to the network directory or call the customer service rep and find someone because that's, that's what they do, right? They, they provide a network. But they, but that's just not the case. Networks are, are really thin relative to need when it comes to mental health and substance use disorder.

Can you speak a little to the underlying economics of it? Because I feel like that's a critical lever.

Well, there's no question that economics play, you know, play a fundamental role in this. At the end of the day, health care in, in the US is a business and insurance companies are mindful of their, of their bottom line. I think the, the reporting that I have read and that has been I'll say best documented suggest that reimbursement rates from insurance companies to in network providers, and that runs from, I'll say frontline therapists, social workers, all the way up to psychologists, psychotherapists and psychiatrists is low, lower than for other equivalent clinical positions in other, other aspects of medicine and healthcare. And in many cases these reimbursement rates haven't changed for years, so they haven't kept up with inflation and they're discouraging to clinicians who are thinking about joining a network. I don't want to say that it's immediately solvable by changing the rates, but we do know that that would make a big difference. I've talked to many therapists who either don't take insurance or have, have never taken insurance. And there I'll say story is, you know, very often I would certainly join a network, but at the end of the day I need to treat my practice as a, as a business and if I can book patients who have private pay and I don't have to worry about reporting to an insurance company and turning over selected parts of the patient file and having someone second guess who My, my training and my expertise sort of, why would I do that? And there's a, you know, sadly, there's a certain logic to that and really sadly that means people that don't have the means to pay out of pocket are really out of luck. And that's, that's just not right.

Yeah, it's, it's very complex. You know, I had co written something a few years ago about the relationship, the doctor patient relationship or the clinician patient relationship, which now has this third party involved, which is often an insurance company. And what we see a lot of times is quite understandably, patients and their families are frustrated, as you said earlier, paying a lot of money, sometimes two or three thousand dollars a month for health insurance, reading that there's supposed to be parity equivalents for mental and general health, and finding insurance companies either, either won't pay or pay very low rates. We know that insurance networks are trying to drive rates down. A lot of our colleagues who see patients find it hard to pay off their, their loans for training. But the, that, that almost sacred doctor patient relationship has gotten undermined. And so a lot of times patients will take out some of their frustrations or have misperceptions of what's happening on the clinician side. So, you know, if you're out of network, patients are sympathetic. We understand it's hard, hard to make it work. If they're in network, they often get this low quality of care that ends up just costing more money down the road. It doesn't even make sense for the insurance companies because it costs them much more money in terms of future mental health and physical health cost outcomes. And so this, this is kind of part of our system. I was talking about this the other day. I was having a conversation, not mentioning names actually, about a family situation on the street and saying how the clinicians, like, don't get back to us. And I, and I understand, like you're saying, like, if you need to have a coordination of care, call with three or four different people. There are billing codes to reimburse for coordination of care, but they're usually not covered. And so how do you make that work as a clinician to provide the best care? And so I was talking about it, and a woman on the street who just overheard the conversation said, are you talking about that hospital? It's the worst. They never get back to you. You call, they never return a voicemail. And so, I mean, it was just one of those moments where I was like, well, it's not just me, right?

Right. Yeah, no, there's a, I mean, there's a level of, I'll say, discouragement, maybe it's even conditioned discouragement among, among clinicians. I was having a conversation with a friend of mine who runs the behavioral health unit for a pretty substantial hospital in the, in the area here, and he told me about how one of his, one of his psychiatrists came in to talk with him about, I think Just what was generally going on in, excuse me, in his particular practice. And among other things, this, the psychiatrist said, you know, one of the insurance companies we're dealing with is, you know, they've, they've really worn me down and I'm, I'm just to the point where I, I just can't fight it anymore. I'm just so discouraged. And my friend who, you know, is this, the senior person running this behavioral health unit said, okay, whatever you do, don't give up because you will be in effect a marked man. They will know you give up and they will know that next time they can very quickly wear you down and that you will not push back on days of coverage or treatment plan or whatever. And he sent his colleague back to do what really is the hard work and sometimes the non reimbursed work of pushing back and saying, I'm the clinician here, I have the direct patient contact, I have the training and the experience and the sort of the armamentarium of generally accepted standards. And I'll make the call here and we can have a conversation about it. But I'm not interested in being doubted just because you want to doubt what I think is the, you know, in my clinical judgment, the right course of treatment.

Right. Sometimes I will. This may be a good tip, but sometimes I will. If an insurance company won't cover something that is medically necessary, ask their legal department to send a letter saying that they're assuming responsibility for the treatment decision. And sometimes that is useful though, if you have someone who's doing say inpatient hospital based work or a busy private practice, if you have three or four people who need those appeals, that's many, many hours a week. And we're supposed to be able to take care of patients during that time and have our own personal lives. And so we see this skyrocketing rates of burnout and a desire for physicians to leave the practice of medicine as a result of this and tragically increasing suicide rates, especially among female physicians. Yeah, yeah, but not exclusively.

There was a, there was a publication just a few weeks ago about a very large hospital system that won a significant judgment against an insurance company. And in the course of the reporting, the CEO of this health system said that they had, I can't remember the exact number, but it was hundreds of people on staff full time and their job was solely to deal with insurance denials. And his comment was that that's ridiculous. Which fact check. Totally true. That's ridiculous.

It's unbelievable. Especially you know, my experience trying to negotiate with them. I think there are a lot of different roadblocks, a lot of different avenues. I'm even thinking when I'm trying to get medication covered, that there are some websites that are really helpful. Each insurance company has its own way that we need to submit this prior authorization, and they have their own requirements for documentation. And even. And I have a real challenge emotionally and practically speaking, when it comes to paperwork. So even when I put all the paperwork together, it seems like they don't look at it and they just deny. And then I'm in the position of having to appeal. And it's a sort of powerlessness that and a frustration knowing that I need to get my patients the medicine that they need to stay stable. I don't know if you have so much experience with the prior authorizations or pharmacy kind of stuff, but is there any recourse that people have or is it just. Well, they say no, and we have to keep pushing for different ways for them to say yes.

Right. So. So I'd love to tell you that I've got a, you know, a magic box of resources that take care of all these. All these things. And I'll say I'm working, I'm working on that. I think the, the principles of certain of the resources on the website, I think, are, I'll say, broadly applicable and can be adapted to use. And here I'm really thinking especially about medical necessity letters. And these are, I'll say, in a way completely obvious to think about once you say it out loud. It turns out that many clinicians are not aware of the concept even of a medical necessity letter and how valuable the, the basic idea of a, of a medical necessity letter is for a clinician to, to document what their. Who they are, what their training is, what their practice is, how they, what their relationship is with the patient, how they're applying generally accepted standards and what they think the next step is. Which is exactly the sort of thing that you would expect if you were talking to a clinician and you were saying, so tell me, you know, tell me what you think ought to get done with your patient, Joe. And it's just putting it in writing with, I'll say, certain concepts in mind, based on the way insurance companies interpret this decision around medical necessity. So let me just interject an observation that was made to me by the head of another psychiatric hospital in New England. Not the, not the same one that, that, that John from that introduced Grant and me talked about, but another one he was telling me about how medical necessity is basically It's a legal concept. It's not a medical concept. He said, so we go to. So he. He's trained as a psychiatrist. He said, you know, we go to medical school and we're taught, do no harm. We're taught, use safe and effective treatment and apply generally accepted standards. That's what we learn. He said, and then. And then we're told that an insurance company is going to judge medical necessity. And he said, it doesn't. Those are not synonymous necessarily. They could be synonymous. And in fact, there are increasingly at the federal and state level, regulations and laws that specify that medical necessity needs to be evaluated on the basis of generally accepted standards. But that's not the law everywhere, and that's not enforced everywhere. I think that's really the key to challenges about care, whether it's with medicines or level of care or even diagnosis, which we know those things can all change in time. And they. And they probably will change in time. That's just. That's how clinicians who are expert like you, as opposed to advocates like me, really, you know, that's how you wake up and go to work every day.

Yeah, that concept of medical necessity, you know, I learned that a long time ago, but particularly as someone who offers transcranial magnetic stimulation, which was only FDA approved or cleared in 2008, we have resources that make it easy to do the paperwork, you know, to your point, Farah, so you don't have to, like, do hours and hours of writing. And I think some of the resources on cover my mental health head in that direction, where a family patient advocate could essentially provide, in a respectful way, you know, support and guidance for a clinician so that it makes their life easier, not harder. And then you kind of learn what are the right things to say. And to the earlier point, during crises, this is especially important. I know from a disaster mental health point of view, as a. As a disaster mental health person, that when people are in a state of crisis, we don't think as clearly our executive function is diminished, our effective educational level is diminished, Judgment and planning and decision making are diminished. So. So it's really important to, you know, essentially have, like, a plan available that you can deploy so that you can be there for your loved ones when they need you and do the pragmatic stuff like the project management, you know, with as little effort as possible. Joe, you mentioned in the Psychology Today interview that you don't know if it's a strategy, but, you know, encouragement and persistence is required because as you said, if you give up, then it's sort of game over. Then you're seen as someone who can be a weak point and a way to, you know, just deny and not have it go anywhere.

Yeah. You know, one of the. One of the very first bits of advocacy that I did when I joined the board of the Kennedy Forum Illinois was to put together a blog post, the something like the 10 steps to insurance Coverage for Mental Health Care. So I was really, really proud of myself. I put this great list together, and then I realized it's nine items too long. The only one that really mattered was get a medical necessity letter. And once I realized that that made such a difference, I got together with Eric Plaikin from Austin Riggs, who I mentioned earlier, and Mark Dabowski, who's a litigator here in Chicago. And we wrote an article about what is a medical necessity letter. And it was published in the Journal of Psychiatric Practice. And the whole idea was to, in effect, teach clinicians about this tool. And on our website, you can download a template in Word so it's easy to apply. It's ready to go. And the whole idea is to provide a clinician, or let's say a really motivated parent who could take a first draft and say, these are not that hard to write, and certainly it's way better than, by the way, you should write a medical necessity letter or what. What the heck is that? So this. This lays it out in a way that is. Is as close to plug and play as as can be. Yep.

We'll share those links in the show notes. And I see that that was also written up on the American Psychiatric Association's website. What occurs to me is, and I hear this all the time about just the business of medicine in general. It is just not a part of training. And so I think it would be great also to have like an elective or a CME available for how to write medical necessity letters. The other thing you mentioned for patients and families to do, which is, like, probably not top of mind when you're worried about life and death issues with your loved one, is to keep a spreadsheet of every single conversation every step of the way. It's much easier to keep a contemporaneous record than it is to go back and look through your cell phone records and reconstruct it. So I think the medical necessity letter on the clinician side and for patients and families to be aware of that and for patients and families to keep that contemporaneous record is just super important. It's also, I'd say, A stress reliever. Because when you've had all these really, I'm going to say disgusting conversations to try to get coverage that you know you deserve, it can be really helpful to document it and empowering. You know, I can give an example from tms. I won't mention like the particular insurance company. It's not an unusual experience though. We set up a call to review a denial and it was hard to set up the call, busy scheduling. I got on the phone with the really lovely doctor who number one. These things are supposed to be peer to peer. So I would like to get on the phone with someone who does TMS and sees how effectively it treats depression. So that doctor said, well, I'm not a TMS trained clinician and also like I understand the predicament you're in, but I'm really not empowered to make any decision unless you have omitted information on the prior auth, such as additional medication history, then I can't do anything for you. And of course I can. You know, you can appeal it. Here's the, you know, the number to call for an urgent appeal. And then I said, well, you know, we were friendly, like collegial. Sometimes it's not so collegial. And she said well we used to have a TMS unit to review these cases but they disbanded it. And so essentially we don't have the option of a true peer to peer or I was mentioning in our pre conversation to the podcast working on behalf of a family member. A medication was denied by someone who did not specialize in that field and I was able to track down that person and have a doctor to doctor call which helped save about three months. But not everyone can do that.

Right. It's really challenging. So to your point about training, I've been hosted on a number of continuing education accredited podcasts or webinars including by the Chicago School, the Illinois association of Behavioral Health and by a NAMI affiliate for the state of Maryland. And that's, I'll say my, I'll say a key way of getting the word out. And I'm certainly open to to contacts about host about opportunities to to share the resources and the background for clinicians in a CE format with, with any of your listeners. So the only thing we don't provide is virtual donuts or pizza, but the content is great and you get a CE credit.

Yeah, we'll definitely follow up with ways to reach out to you. I have in my mind in the interest of time to talk about mental health stigma and how that plays a role in parody. But, Farah, I'm wondering if you had something you wanted to bring up.

Well, just that this is something that we're talking about it and the idea of getting treatment covered. It can enter the treatment in a lot of different ways. And we don't have to go into, let's say, our personal experiences or our professional experiences to know that sometimes this frustration, who's not doing enough, whose fault is it? And the insurance company is like this big, you know, monolith. So I think it is really important to stay encouraged, to keep a united front and know that, okay, your doctor may not have any power, but she's doing everything she can. And that a lot of times these things do work out. It's just a matter of persevering and not backing down. But I think in the interim, you know, weeks and months, and it's so stressful for people who really need a treatment and may be sort of undergoing a financial strain in order to get it. And I do sometimes think, wow, how is this, you know, how is this affecting this person's emotional state and their mental health? Because it can be really deleterious.

Yeah. I mean, it's. Let's say this. I've. I've certainly come to describe this as an all of the above kind of. Of problem, meaning input and resolve and actions are required from so many different perspectives. And I'm convinced that step by step, we can. We can make a difference. But I mean, one way that, that I think of stigma sort of creeping in is, is around the way so many people get access to healthcare, which is through their employers. And when. When there's a challenge with an insurance company, it may be just a little bit harder to go to your human resource department or to your supervisor and say, by the way, the benefit plan that we have is with XYZ Insurance company. And by the way, they're giving me troubles because of, fill in the blank, a substance use disorder, a mental health issue, and I don't know what to do about it. That's a tough conversation. That's a much tougher conversation than with, say, cardiovascular disease or cancer. You know, cancer's come a long, long way. I think that's where cancer was not too many decades ago.

We called it the big C when I was a kid.

Right. A lot of shame about it. And we're. I don't. I'm not going to say we're out of the woods there. It's just. It's still different with mental health, and it's certainly different with substance use disorder. The percentage of people who have mental health or substance use disorder and don't have access to care is many times higher than the level of unavailable care for people that have cardiovascular disease or cancer. It's just not even close.

Yeah, sometimes with mental health notice. Right. Suicide prevention is important. Suicide is an epidemic. I will sometimes call that the big S. And one of the concerns, and you can see this in the national alliance for Mental illness, I think 2024 workplace mental health Survey, is that even when people do have access to mental health services through their EAPs in the workplace, many of them do not feel safe and trusting to approach with those concerns because of that stigma and also because of actual experiences of negative outcomes. So while some EAPs are really wonderful and amazing at supporting mental health and they get that, that's actually better for everyone, for the company, for the staff. I've certainly heard horror stories where people disclose that they have a significant mental illness and they get terminated right away.

Yep. Yeah, no, it's really challenging. And that report is, you know, definitely worth a read. There's a lot that's been published around mental health in the workplace just in the last month or so. And you know, I remember reading it for the first time and seeing that the information about employers performance in providing access to mental health care is as reported by employers. I was thinking, okay, that is maybe useful information if we complement it with information from employees and their families to see just how well it lines up. Because my guess is that it lines up in many respects and doesn't line up so well in other respects. So I think there's an opportunity for us to learn even more about how I think really good intentions and, and appropriate ambitions are confronted then with an insurance company or a third party administrator's reality in making care either available or not so much.

And I guess maybe this is a little potentially too optimistic. But I also think that there is a chance that employers would want to know that their employees are facing these difficulties just because depression, anxiety, those are such big causes of one, disability attrition rates and job loss. And they are treatable and changeable. So I think that's important for employers to be aware of.

No, absolutely. So in 2019, Milliman published a report that specifically called out the dramatically higher cost of medical and surgical care for individuals that did not get access to mental health and substance use disorder care. So that's a really big deal and large employers should be looking, I think, more carefully at those financials to see what the, you know, I'LL say what the reality is just in terms of dollars and cents related to not providing early intervention and preventative care when it comes to mental health and substance use disorder.

Yeah, absolutely. World Health Organization, Lancet Psychiatry had that report that you might be referring to that they found that for every dollar invested in treatment for depression and anxiety, there was on average a four dollar savings. And that's a whole other can of worms. But the other reality of this is people change insurance plans every couple of years, so there's not a lot of incentive to think about long term gains. And with higher attrition rates, you know, companies are thinking, how much do I want to invest in staff wellbeing if they're not going to stick around? And it becomes a vicious circle because the people who stick around are the ones who like where they work.

So let me be just disagreeable on this one point. So those employees are going to go somewhere. So it could be that I'll say investment in prevention and early intervention that one company makes is to the benefit of another when that employee changes jobs.

Well, I would make that point too. If people thought systemically, then it makes perfect sense. It's like how to win the Prisoner's dilemma. We take care of each other. Or it's like that meme where the people have the spoon that's too long to feed themselves at a table and they have to feed each other.

Right. There you go.

Great. And where can people find you and how can they get in touch with you if they want to have you come give a training or an interview?

Sure. So the Our website is covermymentalhealth.org I can be reached directly by email at the email address jovermymental Health. And I certainly welcome all inquiries, whether for CE training or ideas about how to make the website better or other kind of collaborations. You'll also find in the website a collaboration toolkit that may have ideas that are relevant for your practices or your institutions in terms of getting the word out about the resources that we have on offer.

Great. Thank you so much for all the work you do on behalf of all patients everywhere and their families and for being here today to talk about it with us.

Thanks. Thanks so much for this conversation and the opportunity. I'm really pleased with the progress that we've made since we launched earlier this year and there's just so much, so much more progress to be made ahead.

Yeah, thank you, Joe. And likewise for supporting the critical doctor patient relationship, which is one of the most robust factors associated with positive outcomes for patients. Remember the doorknob Comments Podcast is not medical advice. If you may be in need of professional assistance, please seek consultation without delay.

And you can't take it what you see. All my love and make believe. Let me say 1, 2, 3.