Their son was ‘too unstable to function outside of hospital.’ Insurance denied his mental health treatment anyway.

NBC News contacted Quantum Health with a list of questions about Johnathan. In response, a spokesperson for Quantum Health said in a statement: “Quantum Health is not an insurer, insurance company or supplier. We provide navigation and health care coordination services to members on behalf of their employer’s health and well-being program. ”

“Determinations are only based on current policy parameters concerning the cover of a member within the framework of the specific plan and are not a reflection of the value of the care care or a treatment decision,” the spokesperson wrote in an email.

In the letters of denial of Quantum Health, the company writes that the details of the Johnathan case were “examined against the document document and the use criteria adopted by the plan”.

The “use criteria” refer to the internal guidelines used by insurers to assess the way a patient is worn and decide to cover care.

“Many are self-managed by each company and are essentially a black box because we do not know what they are,” said Trestman. “He plays with a stacked card game where the concessionaire is the insurer, and they control everything literally, because even the internal call process is in their business.”

If you deal with invoices that seem to be offline or a refusal of coverage, care or repairs, whether for health, house or car, please send us an email to Costofdenial@nbcuni.com.

According to the insurance documents examined by NBC News, the Benz Bushlings insurance scheme uses a set of directives called interquals produced by Optum, a division of Unitedhealthcare. In a brief brief, dated 2025, the American Medical Association classified the interherite directives as “proprietary and financial criteria”.

“These criteria often leads to care delayed by prior authorization and have denied care through other reasons financially based on profit,” explains the AMA file.

In his declaration to NBC News, Quantum said: “When examining the requests for behavioral health services, we are forced to follow the terms of the specific plan, including its rules for” medical necessity “and the” appropriate level of care “on the basis of recognized national criteria, such as Interqual and Locus”.

“The interqual criteria are objective and specific, helping to guide coherent and defendable decisions that guarantee appropriate and quality care,” explains the Optum website, describing guidelines as a “rigorous development process and based on evidence”.

Benz-Bushlings have appealed to Quantum’s decision three times. Each time, they have been refused.

Before the final denial, Quantum has confused her call to an external company called Allmed Healthcare Management, which she hired to perform an independent exam. Allmed confirmed the denial, arguing that Johnathan had made progress during his treatment and no longer felt suicidal ideas. The letter revealed that he was “largely in accordance with his treatment plan”.

According to Trestman, the signs that a treatment works can be a reason for insurers to move patients to a lower level of care – but he warned that because mental health is fluid, the end of treatment too early can cause a patient’s progress to go back.

“When we document in a graph, we try to reflect that the care we provide help and seek a positive change, but that does not mean that it will remain. This does not mean that it will persist, or that it is something that should justify the reduction in the level of care,” he said.

A 270 -page call

Before this final denial, the Benz-Bushlings had gathered a 270-page call document which illustrated the years of mental health struggle of Johnathan. His depression became notable in 2022, when he started to withdraw from family life and began to vapor the marijuana almost constantly. While entering high school, his dependence problems have become more serious.

“It happened to the point where he had to be escorted wherever he went,” said Benz-Bushling. “He was never supposed to be alone. He always found ways to put the vapes in our house, and he could not spend a school day without getting high.”

To keep their son away from friends who, according to them, provided him with drugs and alcohol, they decided to pack their house in Virginia and move to Michigan earlier this year.

While he was still in Virginia, Johnathan had followed therapy, an intensive ambulatory treatment and an earlier passage in a residential establishment. When the family arrived in Michigan, they thought it was a new start.