Washington families fall deep in debt for mental health care. Why is insurance so spotty?

Starting in fifth grade, his parents put him in a series of treatments, including an intensive outpatient program, group therapy, and evidence-based treatment centers that work with children on anxiety. “We tried everything,” Cohen said.

In 2019, at age 13, he attempted to kill himself. He received immediate care, but the pandemic and the corresponding transition to online school set him back again, and he fell into a deep depression. Most days, he didn’t log on for classes. Discussions with his public high school proved mostly fruitless, his parents said.

In Washington, teens 13 and older have the right to withdraw from mental health treatment — as well as initiate it — without their parents’ consent. His parents thought he wouldn’t get treatment voluntarily and would likely check himself out. They decided in 2021 to send him to a wilderness therapy program in Colorado called Open Sky, which guides students through mindfulness meditation and uses outdoor activities like hiking to stimulate physical and mental health, according to its website.

Upon completion of the program, Cohen’s son attended Gateway Academy in Utah, a residential treatment center.

When he began treatment, Cohen’s family was insured by Premera Blue Cross, the carrier provided by her husband’s employer. Under that plan, only the therapy portion of the wilderness program was covered. Insurance paid about $4,100, she said, and Cohen and her husband were charged about $66,000, according to bills and insurance documents reviewed by The Seattle Times. Premera covered some of Gateway’s costs under a category called partial hospitalization, typical for most residential treatment programs. For each month of care, Cohen was charged about $13,000, and documents show Premera covered about $8,400 of that.