In a Parent's Own Words



"Mental Health and Autism Insurance Project was recommended to me by a treatment program in New Hampshire. Our insurance offered no out of network benefits, and the network offered nothing appropriate within driving distance of our home. The facility in NH met my son's needs perfectly, but it was out of network. The plan said my son could go to a facility in CA, but I knew it would be a nightmare to get him on a plane with his OCD and fear of contamination.

I first connected with Karen, who was direct, knowledgeable and told me exactly what steps I needed to complete in order to try to get an exception from the insurance company. She was VERY efficient and I really felt like my son was being advocated for. None of my questions about the process and what to do seemed like an inconvenience or like a “dumb question.”  

Our initial attempt to get coverage was denied, so the team, which included Marcy, Karen and Allison, worked quickly to appeal the denial. Karen reached out to the Department of Insurance to find out if they could require him to fly across the country, given his condition. Within a day of getting everything signed and authorized, the team had all my info provided for the appeal. The following day, Marcy informed me that we won!

As many people in my situation know, the run-around with insurance is exhausting, and seeing your child suffer from debilitating mental health is a heartbreaking, stressful, entire family experience. Every area of life seems to come to a halt with little to no light at the end of the tunnel. The financial aspect is terrifying. Residential treatment centers are very expensive, but your child's health being in jeopardy is more terrifying.

I would NEVER have known where to start in the process of trying to get an exception to a health facility, or how to go about the appeals process if denied. While our journey continues with case reviews and determinations regarding how my son is doing in the program, I feel, for the first time in months, like there are people who understand my predicament, are willing and able to fight for me and, most importantly, that I have a team supporting me in this lonely and scary journey.

Thank you for fighting for my family and for all the families out there who need a voice. What a remarkable project with remarkable people. I am so grateful for being connected with MHAIP."

Rachel C, Pennsylvania

MHAIP Year-End Wrap Up



2025 has been a whirlwind year, filled with new and exciting activities and people. We recruited four new board members (see story below) who have a lot of energy, relevant experience, and enthusiasm about leading MHAIP into the future. We plan to meet more frequently, and have started working on a five year strategic plan. We have rolled out a new software tool that helps us manage the data connected to our cases and more efficiently track outcomes. A new grant from the Towbes Foundation, reported on in our last newsletter, has brought us into new relationships with providers, helping one agency through their first audit experience (not fun, but part of working with insurance), and others with the process of educating legislators on the many gaps and loopholes in our very imperfect healthcare system.  

The mental health insurance movement experienced a setback last spring , with the Trump administration suspending enforcement of the most recent updates in the MHPAEA (Mental Health Parity) rules. We had started getting traction working with the US Department of Labor, but with recent cutbacks and administrative priorities, this department has less time and availability to actively intervene in problems for those with self-funded health plans. The silver lining, however, is that we’ve been able to develop some outstanding relationships with employers, who sometimes step in and get our families the coverage and payments they need and deserve.  See below in "More Success through Leveraging the Employer."

It would not be 2025 if I did not mention the use of AI. We started using a specialized, HIPAA compliant version which preservers client confidentiality. In a nutshell, it has allowed us to do a lot more with a lot less. We still have to know our stuff, but being able to quickly locate facts, assemble, synthesize and write up information has proven to be invaluable. For board and other meetings, it summarizes and provides useful next steps for action. For what we do, it does not replace anyone’s job, but we can quickly search for answers while on the phone with a client, and get documents written much faster. We do more editing, tweaking, and adding in important information, and less writing from scratch.  AI doesn’t always know what is important to emphasize, and it sometimes overstates things, but so far, it has been a useful tool in the arsenal to help us with our mission to help families get justice in healthcare.

Please remember to donate. Your generous gift helps to train our staff, take on cases where families have fewer resources, supplement our sliding scale, hand off cases to attorneys, update, our computer systems, attend and speak at conferences, educate policy makers, answer questions from impacted families, speak publicly, and make change happen on a wider scale. We are all in this together, and cannot do this work without your generous support. Have a great 2026 and enjoy the holidays.

Sincerely, 

Karen Fessel, Dr PH

MHAIP Has New Board Members!

MHAIP is pleased to announce 4 new members of our Board of Directors. The Board has already begun work on a Strategic Plan to help guide MHAIP as we continue to grow and expand our reach. Meet our Board members below.

Michelle Conover, Ph.D., Q.M.E.

Founder & CEO | Licensed Clinical Neuropsychologist | Expert in Forensic and Rehabilitation Neuropsychology

Dr. Michelle Conover is a licensed clinical neuropsychologist and the Founder/CEO of Southern California Neuropsychology Group (SoCalNPG). With over 20 years of clinical, forensic, and academic experience, she specializes in neuropsychological assessment, cognitive rehabilitation, and expert consultation for children, young adults, older adults, professional athletes, and individuals with traumatic brain injuries. A Ph.D.-level clinician and Qualified Medical Examiner, she completed advanced fellowships at the UCLA Alzheimer’s Disease Research Center and the Sports Concussion Institute.

Dr. Conover integrates brain–behavior analysis into psychotherapy and treatment planning, guiding effective interventions across a wide range of disorders. Under her leadership, SoCalNPG has grown to include a team of clinicians and psychometrists dedicated to ethical, high-quality care. The practice provides comprehensive cognitive, behavioral, and emotional assessments—from achievement testing for school accommodations to complex neurocognitive evaluations in forensic settings.



A published author, speaker, and Clinical Training Director, Dr. Conover is committed to empowering individuals to understand their cognitive profiles, navigate challenges, and reach their full potential.

Michael Griffiths

Michael Griffiths, MBA, SPHR, SHRM-SCP, is the founder and CEO of Spectrum Pride and now serves on the board of the Mental Health & Autism Insurance Project. With 10+ years of leadership in business operations, employment law, and HR, he brings a systems-driven, people-first approach to scaling high-quality autism services. Michael has personally led successful insurance appeals to secure medically necessary care, experience that informs his advocacy work on improving mental health and autism coverage. He holds senior HR certifications from HRCI (SPHR) and SHRM (SHRM-SCP).

Kimberly Ehrlich, N.P.

Kim Erlich is a double-board certified Pediatric Nurse Practitioner and Pediatric Mental Health Specialist practicing in general outpatient psychiatry and in a day treatment program for children and adolescents with eating disorders. She is also a consulting associate faculty member in the pediatric nurse practitioner program at a top school of nursing program, where she develops and teaches pediatric behavioral health curricula. She holds Integrative Mental Health and Nutritional Psychiatry certifications, and regularly integrates this into her care of patients. Kim received her Master of Science in Nursing degree from Yale University, holds a Master of Public Health degree in Maternal and Child Health from Tulane University School of Public Health & Tropical Medicine, is certified in Integrative Mental Healthcare through Evergreen, and in Nutritional Psychiatry through Integrative Psychiatry Institute.

Sharon J. Hendricks

Sharon has been practicing corporate and transactional law for thirty-five years, with deep experience advising boards of public and private technology and life sciences companies on compensation and governance matters. She has a law degree from the University of Chicago and an undergraduate degree in Public Policy from Duke University. She is currently working on a graduate degree in disability theology and ethics, and hopes eventually find a way to use her legal, policy and ethics backgrounds to re-shape our mental health care systems, particularly those involving adolescents and their families. She lives in the San Francisco Bay Area and is the proud mother of a twenty-year-old son and a nineteen-year-old daughter.



Class Action Settlement

in Collins v Anthem

A class action lawsuit against Anthem, originally filed in 2020, was settled on June 30, 2025 with Anthem agreeing to pay $12,875,000 to the Class. Information on how to join the class can be found here. The suit was about the use of MCG guidelines for residential mental health treatment. "Plaintiffs alleged in the Complaints that Anthem denied the Class Members’ requests for coverage of residential treatment on the basis that the care was not medically necessary, using medical necessity criteria that were inconsistent with generally accepted standards of care, more restrictive than the terms of the Class Members’ health benefit plans, and more restrictive than the medical necessity criteria Anthem used for comparable medical/surgical care."

If you were denied residential mental health treatment by Anthem for reasons of medical necessity between April of 2017 and April of 2025, please review the criteria. Don't wait, as the deadline to opt out is 12/19/2025 and the deadline to submit claims is 1/20/2026.

Recent Case Wins by MHAIP

A Note of Gratitude from a Recent Client

On Thanksgiving Day, we received a beautiful message of thanks from a family who recently used our services.

"Can't express how thankful I am to have you as part of my son's village of support. You have alleviated so much stress from the equation by just doing what you do! I hope you know how appreciated you are!" I.F and Family

More Success Through Leveraging the Employer

Following an unsuccessful internal appeal process with the insurance plan, and denial in the external review process, MHAIP secured a material win through a separate appeal offered by the employer. This self-funded plan benefit is quite rare, but with the US DOL offering less regulation, it may be an option that employers consider increasingly in the future. MHAIP won over 250 days (together with a current and forthcoming coverage commitment) for a 16-year-old boy with coexisting developmental disabilities and mental health conditions (including psychosexual symptoms and trauma) in a specialized residential program in Utah. 

After a period of residential treatment, the facility was forced to prematurely step down the level of care to Partial Hospitalization and later Intensive Outpatient treatment, notwithstanding the substantial evidence of his severe behavioral dysregulation, complex neuro, developmental and psychiatric comorbidities, and documented failure of less intensive interventions. The appeal included multiple psychiatric and neuropsychological evaluations, objective risk assessments, and a detailed account of immediate decompensation when care was stepped down, all demonstrating that only a highly structured 24/7 therapeutic environment could ensure his safety and support meaningful progress.

This case was the second significant case where we have recently noted major procedural issues with the external reviewing agency. Despite extensive evidence and a multitude of serious comorbidities, as referenced in both the appeal documentation and the evaluations, only one diagnosis was acknowledged by the reviewer, and the request resulted in a denial. 

Whether this error is a result of the health plan record system or something else, one lesson learned is for families and advocates to place a call to the health plan prior to referral to external review, in order to verify the diagnoses on record and ensure that they received your complete appeal document. Families are also supposed to be sent letters acknowledging receipt from the reviewing agency, so a phone call to the reviewing agency prior to the review may also be warranted.

This employer offered a full review after the external review, so it is often worth your time to call your employer and investigate how they can help.

MHAIP Strategy Secures Full Coverage for 186-Day Medically Necessary Treatment

MHAIP provided crucial guidance to the family of ZZ, an 18-year-old young man with severe, treatment-resistant Obsessive-Compulsive Disorder (OCD) and co-occurring Autism Spectrum Disorder (ASD). His self-funded plan, administered by Anthem, initially approved only a portion of his 186-day stay at a specialized residential treatment center in New Hampshire. Anthem then denied the remaining 102 days as “not medically necessary” and subsequently mishandled the family's first appeal due to a procedural error, incorrectly exhausting their appeal rights. MHAIP helped the family craft a direct, evidence-based appeal to the employer, who was the Plan Sponsor. The appeal highlighted Anthem's failure to provide a “full and fair review” as required under ERISA law and laid out the clear medical necessity for the entire stay. This targeted intervention proved successful, compelling Anthem to reverse its decision and approve coverage for all 186 days of ZZ's medically necessary treatment.

"Through persistence and deep knowledge of the (very flawed) insurance system, Marcy Smith was able to get the coverage my son needed for his 6-month residential treatment. It's not only the money: it's getting the system to recognize the medical necessity of evidence-based treatment for cases like my son's."

Medical Necessity and Single Case Agreement Won on Appeal

MHAIP helped a family from California whose daughter was moving from a program in NC to a new program in Utah due to the program closing (after winning an SCA for the prior program).  The billing company working on behalf of the Utah facility advised the family that it was not likely they would get pre-authorization given the daughter had been in treatment somewhere else and received coverage.  MHAIP advised the family it was a solid case and always worth trying, which was true in this instance.  MHAIP secured authorization for the initial 43 days of her care after which the insurer issued a denial. The insurer also denied our request for a Single Case Agreement (SCA).  MHAIP filed an appeal requesting an overturn of the medical necessity denial of care from denial date through discharge and requested an SCA for her entire stay.  We won an overturn for an additional 133 days, and an SCA for the entire 176 authorized dates of service.  We anticipate an additional $415 per day of the allowed amount for the 176 days, or $73k, due to the Single Case Agreement, demonstrating the importance of requesting an SCA whenever possible.  In total the family will recoup roughly $140k for her care in Utah.

Highlights of Pre-Authorization/UR Services

SG, a 19-year old from Washington, DC with OCD, MDD and POTS received 131 days authorized from BCBS of NJ at a treatment center in New Hampshire.

LM, a 20-year old from New Jersey with Autism Spectrum Disorder, OCD, Excoriation (Skin-Picking) Disorder and ADHD received 72 days authorized from UMR at a treatment center in New Hampshire.

JR, a 20-year old from California with Autism Spectrum Disorder, MDD, BDD and OCD received 85 days from United at a treatment center in New Hampshire.

LC, an 18-year old from New Hampshire with OCD and Persistent Depressive D/O received 73 days from Anthem at a treatment center in New Hampshire.

TV, a 16-year old from NJ with MDD, GAD and ADHD received 78 days from United at a treatment center in New Hampshire.

SW, a 16-year old from MA with GAD, Persistent Depressive Disorder and ADHD received 92 days from UMR at a treatment center in New Hampshire.

NF, a 15 year old from NY with Panic Disorder, GAD and Persistent Depressive Disorder received 92 days from Emblem Health at a treatment center in New Hampshire. 

Donate Now to our General Fund

General Fund supplements our sliding scale program, pays for educational seminars and workshops for families and professionals, helps with policy work and allows us to provide free advice to families needing help with insurance.

Donate to the Feda Fund

We will need your continued financial support to be able to keep this wonderful program, which allows us to provide assistance to financially struggling families and keeps Feda and Mu’s memories alive in our hearts.  Thank you for your active support.