![\"Jonathan](\"https:\/\/www.newsbeep.com\/il\/wp-content\/uploads\/2025\/09\/852515abe2d25165a3782ac026195af0.jpeg\"\/)
<\/p>\nNick Benz-Bushling never imagined that managing his son\u2019s mental health care would turn into a real-life horror story.<\/p>\n
After years of struggles, 16-year-old Johnathan attempted suicide in February.<\/p>\n
Benz-Bushling 41, and his wife Misty Benz-Bushling, 39, of Stephensville, Michigan, rushed Johnathan to the emergency room, and then later took him to Forest View Hospital, an inpatient behavioral health facility in Grand Rapids that had room in its pediatric psychiatry unit. When a doctor there said Johnathan needed residential treatment, the Benz-Bushlings immediately found him a bed at Newport Academy in Washington.<\/p>\n
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\u201cI was angry at myself,\u201d Johnathan said. \u201cI was upset that I disappointed my parents, because I knew they expected better for me and that I could be better.\u201d (Alfield Reeves for NBC News)<\/p>\n
\u201cI\u2019m just trying to make sure that he\u2019s getting the help that he needs. Honestly, I\u2019m not thinking about insurance or anything like that,\u201d Benz-Bushling said. \u201cLet\u2019s get him somebody that can help him through these hard times, because we\u2019re not it.\u201d<\/p>\n
They didn\u2019t realize the race to get Johnathan into treatment would be the start of an insurance battle <\/a>that would upend their family\u2019s finances<\/a>. In the coming months, Misty Benz-Bushling would leave her job. Her husband sold some of the rare Stephen King memorabilia that decorates their home. The couple drastically scaled back on activities for their three other children.<\/p>\n Nick Benz-Bushling collects rare, first edition Stephen King novels. (NBC News)<\/p>\n In discharge papers from Forest View, a doctor wrote: \u201cPatient too unstable to function outside of hospital. Patient\u2019s treatment needs cannot be expected to be met in a lower level of care.\u201d<\/p>\n The Benz-Bushlings\u2019 insurance provider disagreed.<\/p>\n Five days after Johnathan entered treatment at Newport Academy, his parents received a letter denying coverage for his stay \u2014 deeming it \u201cnot medically necessary\u201d and writing that \u201ctreatment could be provided in a less restrictive level of care.\u201d<\/p>\n \u201cIt was just completely the opposite of what the doctors at the intermediate facility said,\u201d his father said.<\/p>\n \u201cA care coordinator for insurance called and said, \u2018Hey, can we help you find a therapist in town?\u2019 And I was angry, I was upset, and I was crying, and I told her, if my son comes home now, he will end his life, and the blood will be on your hands,\u201d his mother said.<\/p>\n A childhood photo of Johnathan in his bedroom. (Alfield Reeves for NBC News)<\/p>\n \u201cThe system is badly broken\u201d<\/p>\n The Benz-Bushlings\u2019 experience is far from unique.<\/p>\n Nearly 60 million adults <\/a>in the United States live with a mental health condition, however, only about 50% receive treatment, because of a variety of factors. According to the American Psychological Association, 20 million children<\/a> in the U.S. have also been diagnosed with a mental health disorder and that number is estimated to be growing.<\/p>\n Mental health treatment in the U.S. cost $106.5 billion<\/a> in 2019, according to a report from the Agency for Healthcare Research and Quality \u2014 of which private insurance paid about a third. In 2021, pediatric mental health conditions were associated with $59 billion in household spending<\/a>, and made up 46.6% of all pediatric medical spending.<\/p>\n As the stakes get higher for patients with more serious mental health needs, so do the costs. A 2024 study <\/a>found that residential addiction treatment centers for minors are \u201climited and costly.\u201d The average cost quoted for a month of treatment was more than $26,000.<\/p>\n According to Dr. Robert Trestman, chair of the American Psychiatric Association\u2019s Council on Healthcare Systems and Financing, stays in residential facilities typically last one to three months. Due to the high costs, he said, insurance companies are incentivized to look for reasons to send patients to a lower level of care.<\/p>\n \u201cBecause of the financial incentives, it\u2019s become painful, and it\u2019s at every level,\u201d he said. \u201cThe system itself is broken badly.\u201d<\/p>\n Insurance companies review patient files to determine whether care is medically necessary, which can be subjective, given that mental health conditions are often invisible.<\/p>\n \u201cMedical necessity is not a black and white,\u201d Trestman said. \u201cIt is a clinical determination, and the words used and the criteria vary.\u201d<\/p>\n Dr. Sara Coffey, leadership chair of the department of psychiatry and behavioral sciences at the Oklahoma State University Center for Health Sciences, said residential treatment is an appropriate tool for pediatric patients<\/a> who have attempted suicide, and for whom other kinds of therapy have been ineffective. Coffey wasn\u2019t involved with Johnathan\u2019s care.<\/p>\n \u201cResidential really does serve a role in that continuum for kids that are just not progressing or that have safety concerns with their outpatient care,\u201d Coffey said. \u201cIf there\u2019s repeated suicide attempts, or if it feels like the work that we\u2019re doing outpatient really isn\u2019t leading to meaningful results, then that is often when residential can provide that additional structure and support to help kids heal.\u201d<\/p>\n The Benz-Bushlings are self-insured through the husband\u2019s job as an electrical engineer at American Electric Power, which means medical care is paid for by the employer, instead of a larger insurance company. In this type of arrangement, an employer will usually outsource the logistics of approving or denying coverage to an outside company.<\/p>\n In this case, the Benz-Bushlings\u2019 insurance plan lists Quantum Health as the \u201ccare coordinator\u201d that is responsible for determining coverage eligibility.<\/p>\n Nick and Misty Benz-Bushling appealed Quantum Health’s decision three times. Each time, they were denied. (Alfield Reeves for NBC News)<\/p>\n NBC News reached out to Quantum Health with a list of questions about Johnathan\u2019s case. In response, a Quantum Health spokesperson said in a statement, \u201cQuantum Health is not an insurer, insurance company or provider. We provide healthcare navigation and care coordination services to members on behalf of their employer\u2019s health and welfare benefits program.\u201d<\/p>\n \u201cDeterminations are solely based on current policy parameters regarding a member\u2019s coverage under the specific Plan and are not a reflection of the value of the care requested care or a treatment decision,\u201d the spokesperson wrote in an email.<\/p>\n In the denial letters from Quantum Health, the company writes that the details of Johnathan\u2019s case were \u201creviewed against the plan document and the utilization criteria adopted by the plan.\u201d<\/p>\n \u201cUtilization criteria\u201d refers to internal guidelines used by insurers to assess how well a patient is doing and to decide whether to cover care.<\/p>\n \u201cSo many are self-generated by each company and are essentially a black box because we outside don\u2019t know what they are,\u201d Trestman said. \u201cIt\u2019s playing with a stacked deck of cards where the dealer is the insurer, and they control literally everything, because even the internal appeals process is inside their company.\u201d<\/p>\n If you are dealing with bills that seem to be out of line or a denial of coverage, care or repairs, whether for health, home or auto, please email us at Costofdenial@nbcuni.com.<\/a><\/p>\n According to insurance documents reviewed by NBC News, the Benz-Bushlings\u2019 insurance plan uses a set of guidelines called InterQual that are produced by Optum, a division of UnitedHealthcare. In an issue brief dated 2025, the American Medical Association classified the InterQual guidelines as \u201cproprietary, financially-driven criteria.\u201d<\/p>\n \u201cThese criteria often lead to delayed care through prior authorization and denied care through other financially driven, profit-based motives,\u201d the AMA brief says.<\/p>\n In its statement to NBC News, Quantum said \u201cWhen reviewing requests for behavioral health services, we are obligated to follow the terms of the specific Plan, including its rules for \u2018medical necessity\u2019 and \u2018appropriate level of care\u2019 based on nationally recognized criteria, such as InterQual and Locus.\u201d<\/p>\n \u201cInterQual Criteria are objective and specific, helping guide consistent, defensible decisions that ensure appropriate, quality care,\u201d Optum\u2019s website says<\/a>, describing the guidelines as a \u201crigorous, evidence-based development process.\u201d<\/p>\n The Benz-Bushlings appealed Quantum\u2019s decision three times. Each time, they were denied.<\/p>\n Nick Benz-Bushling doles out Johnathan’s medications. Nick and Misty Benz-Bushling still keep all alcohol and medicines locked in their bedroom. (Alfield Reeves for NBC News)<\/p>\n Before the final denial, Quantum routed their appeal to an outside company called AllMed Healthcare Management, which it hired to conduct an independent review. AllMed upheld the denial, arguing that Johnathan had made progress over the course of his treatment and was no longer experiencing suicidal ideation. The letter found that he was \u201clargely compliant with his treatment plan.\u201d<\/p>\n According to Trestman, signs that a treatment is working can be grounds for insurers to move patients to a lower level of care \u2014 but he cautioned that because mental health is fluid, ending treatment too early can cause a patient\u2019s progress to backslide.<\/p>\n \u201cWhen we document in a chart, we\u2019re trying to reflect that the care we\u2019re providing is helping and looking for positive change, but that doesn\u2019t mean that it\u2019s going to stick. That doesn\u2019t mean that it\u2019s going to persist, or that it\u2019s something that should justify reducing the level of care,\u201d he said.<\/p>\n A 270-page appeal<\/p>\n Before that final denial, the Benz-Bushlings had assembled a 270-page appeal document that illustrated Johnathan\u2019s years of mental health struggles. His depression<\/a> first became noticeable in 2022, when he started to withdraw from family life and began vaping marijuana almost constantly. As he entered high school, his addiction issues became more serious.<\/p>\n \u201cIt got to the point where he had to be escorted everywhere that he went,\u201d Benz-Bushling said. \u201cHe was never supposed to be alone. He was still finding ways to get THC vapes into our house, and he couldn\u2019t get through a school day without getting high.\u201d<\/p>\n To get their son away from friends who they said supplied him with drugs and alcohol, they decided to pack up their home in Virginia and move to Michigan earlier this year.<\/p>\n While still in Virginia, Johnathan had done therapy, intensive outpatient treatment and one earlier stint at a residential facility. When the family arrived in Michigan, they thought it was a fresh start.<\/p>\n To pay for Johnathan’s treatment, Nick Benz-Bushling sold some of the rare Stephen King memorabilia that decorates their home. Misty quit her job to make sure her son had full-time care. (Alfield Reeves for NBC News)<\/p>\n But after several weeks of sobriety, Johnathan was once again suspended from school and found his parents\u2019 alcohol supply, which was hidden in their bedroom closet. He drank to the point of blacking out while his parents were both at work. His parents returned home to find that he\u2019d vomited and passed out.<\/p>\n Filled with shame for disappointing his parents when he woke up, Johnathan tried to end his own life.<\/p>\n \u201cI was angry at myself,\u201d Johnathan said. \u201cI was upset that I disappointed my parents, because I knew they expected better for me and that I could be better.\u201d<\/p>\n \u201cIt\u2019s so hard knowing that you can\u2019t keep your kids safe at home, and that the struggles that he\u2019s having with mental health are so much that he thinks he doesn\u2019t want to be here anymore, and how do you keep him safe and help him work through it?\u201d his mother said.<\/p>\n With this history in mind, the Benz-Bushlings decided to pay out of pocket for as long as they could for Johnathan\u2019s treatment.<\/p>\n \u201cThe director of the facility caught wind and called me and said, \u2018He needs to be here. I can\u2019t let him go. So what do we need to do?\u2019\u201d Misty Benz-Bushling said. \u201cHe said, \u2018It would be unethical for me, as a medical professional, to send him home at this point, because he needs the treatment.\u2019\u201d<\/p>\n A Newport Healthcare feedback form; Johnathan in his bedroom. (Alfield Reeves for NBC News)<\/p>\n Misty Benz-Bushling was able to negotiate a discounted rate with Newport Academy. Still, they were only able to keep Johnathan there for seven weeks, instead of the full nine that was recommended. The stay cost the family tens of thousands of dollars.<\/p>\n To cover the costs, the couple took out a high-interest loan for $25,000. They also sold some belongings to fill in the gaps, like Benz-Bushling\u2019s collection of rare, first-edition Stephen King books.<\/p>\n Misty Benz-Bushling left her job to ensure that Johnathan had full-time care when he returned home. They cut back on travel to visit family, as well as going out to eat and taking their younger children to the movies. Their oldest daughter had to switch colleges and enroll in virtual school because they can no longer help her with tuition payment.<\/p>\n To try and recover some of their costs, the Benz-Bushlings threatened a lawsuit against American Electric Power to recover their out-of-pocket costs.<\/p>\n NBC News reached out to American Electric Power four times after interviewing the Benz-Bushlings. One week after a followup email to the company, the Benz-Bushlings\u2019 lawyers informed NBC News that the family and the company resolved their dispute. The terms are confidential.<\/p>\n After learning of the settlement, NBC News followed up again with American Electric Power.<\/p>\n \u201cWe are pleased that the family was able to resolve their concerns and that we were able to assist. AEP offers benefit plans that include access to a broad range of healthcare, including mental health services. In doing that, AEP does not play a role in determining what treatment is provided to any covered individual or in communicating determinations that are made under our plans,\u201d a company spokesperson said in an email.<\/p>\n After treatment, Johnathan\u2019s mental health has improved. He\u2019s been able to get a summer job at a local hardware store and go fishing with friends.<\/p>\n Johnathan’s mental health has improved since treatment, and Nick and Misty Benz-Bushling see a positive change in their son. (Alfield Reeves for NBC News)<\/p>\n \u201cI was upset that they had to, but I was also really grateful,\u201d he said of his parents paying out of pocket for his care.<\/p>\n The Benz-Bushlings see a positive change in their son, and say the sacrifice was worth it to get the help he needed. Still, they\u2019re angry that their insurer denied coverage \u2014 and they\u2019ve installed locks on their bedroom door, where alcohol and medications still remain hidden.<\/p>\n \u201cMaybe insurance companies will see this and say, \u2018Oh, these are real people out there. It\u2019s not just a stack of paper,\u201d Benz-Bushling said.<\/p>\n If you or someone you know is in crisis, call 988 to reach the Suicide and Crisis Lifeline. You can also call the network, previously known as the National Suicide Prevention Lifeline, at 800-273-8255, text HOME to 741741 or visit SpeakingOfSuicide.com\/resources<\/a> for additional resources.<\/p>\n If you or someone you know is struggling with an alcohol, drug or other substance abuse problem, call the free and confidential helpline of the Substance Abuse and Mental Health Services Administration at 1-800-662-HELP (1-800-662-4357), or visit findtreatment.gov<\/a>.<\/p>\n![\"A](\"https:\/\/www.newsbeep.com\/il\/wp-content\/uploads\/2025\/09\/642508370e90b49462dec6309ee13874.jpeg\"\/)
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