What is a Behavioral Health Ombudsman?

NYAPRS Note: Earlier in this year’s NYS budget session, NYAPRS joined a broad coalition headed up by the Legal Action Center to urge state legislators to create a new behavioral health ombuds program. Here’s the letter we signed on to below. We’re hoping to learn over the next day so if this important new initiative has been funded.

Dear Legislative Leadership:

The Senate and the Assembly have played a vital role in fighting the growing opioid epidemic in New York State. We applaud your work on removing barriers to accessing medically necessary treatment. Unfortunately, even with the passage of groundbreaking State and Federal laws we are seeing an alarming increase in individuals being denied access to the care they need. Due to the growing epidemic and our complicated insurance system, there is a critical need for a statewide behavioral health ombudsman to monitor behavioral health parity violations.  We, the undersigned, ask you to allocate $1.5 million in the Senate and Assembly one-house bills and final budget to fund this vital project.

We have seen firsthand the devastating impact substance use disorder and other mental health issues have on the individual, family, and community alike.  Conversely, we have also seen countless lives saved when individuals are afforded access to appropriate and timely treatment.  Like most chronic diseases, treatment for substance use disorder should be decided on by the patient and medical professional, not insurance companies.  However, even in the wake of the epidemic, insurers are failing to treat addiction with the same sense of urgency as other deadly diseases. If insurers continue to deny coverage, we will continue to see a significant increase in deaths across the state.

In many cases, individuals living with a SUD do not have the resources and support systems in place to spend several hours haggling with a health plan over covered benefits and reimbursement methodologies. Further, many people are unaware of their coverage and the rights afforded to them by the Parity Act. There is a pressing need for additional services, especially given the continued upswing of individuals facing substance use disorder (SUD). The ombuds program will fill this gap in services and create a continuum of care that the SUD population needs and deserves. 

The ombudsman will work with community based organizations and providers and provide them with the training, materials and technical assistance necessary to better serve the behavioral health community. Additionally, the ombudsman will educate consumers of their rights to insurance coverage; help navigate the insurance system; and use their health coverage to secure and pay for treatment and services.