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

NBC News reached out to Quantum Health with a list of questions about Johnathan’s case. In response, a Quantum Health spokesperson said in a statement, “Quantum Health is not an insurer, insurance company or provider. We provide healthcare navigation and care coordination services to members on behalf of their employer’s health and welfare benefits program.”

“Determinations are solely based on current policy parameters regarding a member’s coverage under the specific Plan and are not a reflection of the value of the care requested care or a treatment decision,” the spokesperson wrote in an email.

In the denial letters from Quantum Health, the company writes that the details of Johnathan’s case were “reviewed against the plan document and the utilization criteria adopted by the plan.”

“Utilization criteria” refers to internal guidelines used by insurers to assess how well a patient is doing and to decide whether to cover care.

“So many are self-generated by each company and are essentially a black box because we outside don’t know what they are,” Trestman said. “It’s 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.”

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According to insurance documents reviewed by NBC News, the Benz-Bushlings’ 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 “proprietary, financially-driven criteria.”

“These criteria often lead to delayed care through prior authorization and denied care through other financially driven, profit-based motives,” the AMA brief says.

In its statement to NBC News, Quantum said “When reviewing requests for behavioral health services, we are obligated to follow the terms of the specific Plan, including its rules for ‘medical necessity’ and ‘appropriate level of care’ based on nationally recognized criteria, such as InterQual and Locus.”

“InterQual Criteria are objective and specific, helping guide consistent, defensible decisions that ensure appropriate, quality care,” Optum’s website says, describing the guidelines as a “rigorous, evidence-based development process.”

The Benz-Bushlings appealed Quantum’s decision three times. Each time, they were denied.

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 “largely compliant with his treatment plan.”

According to Trestman, signs that a treatment is working can be grounds for insurers to move patients to a lower level of care — but he cautioned that because mental health is fluid, ending treatment too early can cause a patient’s progress to backslide.

“When we document in a chart, we’re trying to reflect that the care we’re providing is helping and looking for positive change, but that doesn’t mean that it’s going to stick. That doesn’t mean that it’s going to persist, or that it’s something that should justify reducing the level of care,” he said.

A 270-page appeal

Before that final denial, the Benz-Bushlings had assembled a 270-page appeal document that illustrated Johnathan’s years of mental health struggles. His depression 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.

“It got to the point where he had to be escorted everywhere that he went,” Benz-Bushling said. “He was never supposed to be alone. He was still finding ways to get THC vapes into our house, and he couldn’t get through a school day without getting high.”

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.

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.