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High-profile interview leads to a five-part series on mental health parity Date: 05/23/19

By Yen Duong, Ph.D.

Hurricane Florence hit during my first two weeks at North Carolina Health News last September. I was building a new beat in Charlotte, three hours farther inland than my colleagues in Raleigh. Despite a summer as an AAAS Mass Media Fellow at the Raleigh News & Observer, I was still new to journalism.

Despite the storm, one of the state’s largest health systems decided to continue with a planned fundraising event in Charlotte. I headed over to interview Patrick J. Kennedy, the former congressman from Rhode Island and mental health advocate, expecting to be elbowed aside at a press conference. Instead, since every other outlet was covering Florence, I was able to do a half-hour interview with Kennedy that was published as a Q&A.

The following month marked the 10th anniversary of the Mental Health Parity and Addiction Equity Act, which Kennedy had pushed through. His nonprofit marked the occasion by issuing report cards to each state on how well their laws protected parity, which meant treating mental health on par with physical health. Since I had done the Kennedy Q&A, my editor asked me to take a look at the report card.

I wrote a quick piece, but in the process someone at the N.C. Department of Insurance mentioned that were was a dedicated DOI employee who handled parity-related complaints. That spurred me to file a public records request with the help of a colleague. I ended up with 59 complaint records. My editor, Rose Hoban, suggested I create a spreadsheet to keep track of the information and read through the records, and the project kept spiraling.

Many patients and providers refused to talk, but luckily, I had a long list of people to try. I reached out to 26 people and ended up with nine interviews. The providers were okay with being on the record with their names, but we gave anonymity to patients. Several teenagers were struggling to get on their feet after dealing with substance abuse and feared being stigmatized at a new workplace. Other people feared losing clients at their businesses if word got out about their mental illnesses.

The people who did talk to me were extremely eager to talk and help me out. They didn’t want other people to have to devote same hours of phone calls, inches of paperwork and thousands of dollars that they had.

Over the course of the next three months, I learned about external reviews and the appeals process, met patient advocates and talked with national nonprofit leaders. Each person I talked to pointed me to the next source.

Originally, I was going to write one article about the report card, but my project ballooned to five stories:

• An introduction to parity and how and why North Carolina received an “F” on the Kennedy Forum report card

• Patient stories and how to file complaints

• Provider stories and how providers join insurance panels

• How to identify a parity problem

• How to solve a parity problem (as New York and Illinois did)

Utilizing graphs was an unexpected perk of writing these stories. I have a math background, but as a journalist hadn’t worked with data like this before. One graph created for the series showed differing rates of success of external appeals with different independent review organizations. IROs help consumers and health insurers resolve coverage disputes. No one told me that a patient’s chances of getting a denial overturned would change depending on which IRO was assigned to them, so I had the graph say it instead.

My inexperience helped me in tackling this complex topic. Not knowing how complicated and drawn-out this project would be, I was willing to dive in. I ended up doing my first public records request, my first project that required spreadsheets to track data (I ended up with four) and my first video, the latter thanks to a colleague’s tutorial in Adobe Spark. My editor taught me what a story budget was and helped me separate my massive project into five coherent parts. Since I was so new, neither of us knew how long it would take me to write stories or how much output to expect of me.

For other health care journalists tackling the issue of mental health parity, my best advice is to stay organized with a story budget, separate folders for each planned story and every week or so, check in to review the big picture you have for the project. This project included 20 interviews and documents ranging from six to 120 pages long. One of the most frustrating aspects was getting insurance companies to respond. I have an email thread of 53 messages with one public relations person and the result was still no comment. That fits with the theme of the entire project of the difficulty of dealing with insurers.

Resources

Journalists seeking to track legislative, regulatory and other activities on mental health parity in all 50 states and at the federal level on how well health insurers are complying with parity laws can check Parity Track, a site the Kennedy Forum sponsors.

For information on how to file a complaint about a lack of compliance with parity laws, visit the Parity Registry, another site the Kennedy Forum sponsors.

Yen Duong, Ph.D., covers health care in Charlotte for North Carolina Health News. Last year, she was a mass media fellow for the American Association for the Advancement of Science where she worked at the News & Observer in North Carolina. She has a doctorate in mathematics from the University of Illinois in Chicago. Follow her at @yenergy.