Jan. 13--She always brought the cream cheese pinwheels and relish tray for Thanksgiving, but there were none on the table this time. Thanksgiving, then Christmas, came and went without the youngest of the three Bennett sisters from Paola, Kansas.
Before she went to bed on April 18, just a month before her 29th birthday, Kristi Bennett took 15 Wellbutrin antidepressant pills, her family says.
She didn't wake up.
Bennett's relatives don't believe she intended to end her life, that it was an accidental overdose. What they do know is that their sister, their daughter, a slip of a woman who could hunt mushrooms better than her dad, was suffering and couldn't get help.
By their accounts, she was stymied by her health insurance company and the mental health facilities she tried to get into. Now she's gone, and her family is angry at a health care system they say places mental health or substance abuse patients on a tier below those with physical diseases.
A bill in the Kansas Legislature with her name attached to it could fix some of those disparities, its supporters say, by eliminating insurance red tape that slows access to mental health treatment.
Two state senators, one a Republican, one a Democrat jointly introduced the bill, which Kansas lawmakers will consider after their annual session begins Monday.
In the days before she died, Bennett and her family called more than a dozen facilities, in Kansas and out of state, looking for help, the family says. They say she had medical insurance through Blue Cross and Blue Shield of Kansas.
In a statement to The Star, the company said federal privacy law prevents it from discussing Bennett's personal health information, a rule that applies for 50 years after a person dies.
"Our hearts go out to the family and friends of Ms. Bennett, as they cope with their heartbreaking loss," Blue Cross said.
Bennett knew she needed help, her family said.
"That's my baby sister. I just can't believe this happened to her," said her older sister Jennifer Cook, who lives in Paola. "She was fine and then she wasn't fine. And that right there tells you it could happen to anybody. I mean, anybody."
Kansas gets a 'D'
While Kansas has laws requiring parity between coverage of mental health and physical health, supporters of the bill say they aren't enough.
ParityTrack, a site that follows such legislation across the country, gives Kansas a "D" grade on its state law. (Missouri got a D, too.)
"The promise of parity remains elusive for many individuals directly impacted by mental illness and substance use disorders. They are denied care when they need it most and have few resources to advocate on their own behalf," Parity Track notes of both states.
"Based on deficiencies found in our analysis of state statutes, Kansas should consider: How mental health and addiction conditions are covered. How compliance with the parity law is monitored and enforced."
Under the bill, insurance companies couldn't decide against covering mental health treatment if a doctor says it's needed.
It would also require them to allow network exceptions within 24 hours if no in-network facility is immediately available.
The proposal is part of ongoing efforts by Kansas lawmakers to combat suicide, as the suicide rate, especially among young people, continues to climb.. Kansas now has a youth suicide prevention coordinator, and a 2016 law requires school staff to receive regular suicide prevention and awareness training.
The two northeast Kansas senators who filed the bill -- Republican Molly Baumgardner of Louisburg and Democrat Tom Holland of Baldwin City -- said the legislation is aimed at getting insurance companies to treat mental health care the same as physical health care.
Baumgardner uses this analogy to help people understand: What if patients find out they have a coronary artery blockage but are told their insurance company won't cover a stent surgery until after a heart attack?
"That seems pretty irrational, doesn't it? That's not how it operates, but that's what's happening with individuals facing mental health crises," Baumgardner said.
Cook and her family are unlikely policy crusaders. Cook, the mother of four, is a portrait photographer who takes pictures of babies and families in the sunny addition she and her husband built onto their rural home. She is more comfortable behind the camera than in front of it.
When the bill bearing her sister's name was announced at the state Capitol on Dec. 19, Cook and her sister, Stephanie Bennett of Lenexa, and their mom, Christina Wharton of Richmond, near Ottawa, stood in front of microphones and cameras, trying not to cry.
"My sister wasn't given any other options. So she decided to try to go around the system. And as a result she's no longer with us today," Cook told reporters. "My sister mattered. ... Life is more important than insurance company profits."
The bill came about in part through the efforts of Mark Desetti, a well-known lobbyist for the Kansas National Education Association.
"Last April, I got a phone call from my son and he was crying and struggling to speak," Desetti said at the press conference. "What he managed to get out eventually were three words that changed my life, changed his life and changed the lives of all the people you see behind you today. He said: 'Kristi is dead.' Three words."
Since the media coverage of that day in Topeka, Cook has been flooded with messages from people saying they had a loved one suffering mental anguish who had died by suicide, "which is so sad to be in this club," Cook said.
The "club" includes Chris Lengquist, a real estate agent and father of four in Olathe. In February 2018, his 20-year-old daughter, Emma, whom he and his wife adopted from the foster care system, took her life. He blogs about her at GlitchesandSmiles.com.
His daughter's journey through the complicated mental health care system inspired him to both pledge support for the Bennett bill and run this year for a seat in the Kansas Senate.
Mental health is a crisis
Everyone knows someone with a serious mental health or substance abuse issue, said Holland, the bill's co-sponsor.
"It is imperative that Kansas lawmakers begin knocking down those barriers that would deny life-saving services and treatment to those Kansans desperately crying out for help at a time of crisis," he said.
Rep. Tom Cox, an Overland Park Republican and vice chair of the House Insurance Committee, said "everyone across the political spectrum" agrees there's a mental health crisis.
If the bill is considered a mandate on insurance companies, he said, the companies will push back by highlighting the costs of the legislation and how it will raise premiums.
"I imagine it won't go through smoothly," Cox said.
In its statement, Blue Cross said mental health care is a top priority.
"We must not separate the mind, body and spirit. We know that stigmas still exist surrounding mental health, and we will continue to educate members and providers to ensure everyone gets the care they need," the company said.
"Since the mental health parity laws were passed in 2009, we have been working to assure our members have access to all the benefits they are entitled to, while also creating policies and procedures to ensure that behavioral health benefits are administered in the same manner as medical services benefits, which was a goal of the mental health parity law."
A spokesman for Kansas Insurance Commissioner Vicki Schmidt said she doesn't weigh in on legislation that is not part of her office's legislative agenda and declined to take a position on the bill.
"Certainly mental health parity is an issue close to the Commissioner's heart, she believes there is still work to be done to help Kansans get the care they need and has full confidence in the committee process and her former colleagues to ask the right questions and work to find solutions for Kansans," spokesman Lee Modesitt said. Schmidt was previously a state senator.
A fall into despair
Jerry Bennett cannot speak about his daughter without getting emotional. At Christmas there was only one stocking on his fireplace mantel, and it was Kristi's.
"She was my buddy," said her father, who is now taking care of her teacup Yorkie, Meeko. "She loved life and she was fun. She had a dry sense of humor like I do. We kind of understood each other.
"She was ready to make a new beginning. She had hope. She was ready to make a move and get things going."
Jerry Bennett, who works for the Miami County Rural Water District, said his daughter, who had lost her job as a massage therapist, talked excitedly to him the weekend before she died about finding a new job.
The family watched trauma after trauma fall onto her slim shoulders over the last 12 years.
Her father said her struggles began in high school after she was sexually assaulted by another teenager at a party. She watched her assailant subsequently have his record expunged, then allegedly assault another woman, then remake his life out of state, and she grew angry and frustrated, the family says. "That's kind of what started it all," her father said.
She went into therapy and began taking antidepressant and anti-anxiety medications. Over the years, being switched from this prescription to that, she suffered seizures so severe her family took her to the emergency room. They worried she wouldn't survive the pharmaceuticals.
They believe she needed more than the handful of counseling visits her insurance would pay for. And she couldn't afford out-of-pocket costs, they say.
"That's what part of this bill would give you," said Cook. "If you were a diabetic, would they cut off your insulin? It would be unlimited, as long as she needed it. She should have had it until she was better."
Cook believes her sister's final fall into despair began in October 2018, when a 12-year-old girl, the daughter of a man she used to date, died along with two other children in a car crash on Kansas 68 highway between Paola and Ottawa.
Cook was with her sister when they walked into the visitation and saw three little caskets lined up. They were at the funeral and watched yellow school buses roll up carrying the dead children's classmates.
And then, one of Bennett's best friends died.
'I want her back'
A few days before she died, Bennett moved to Lenexa to stay with her sister, Stephanie, a registered nurse who works on open heart surgeries at Children's Mercy.
Bennett had broken up with her boyfriend. She was depressed. And she was drinking, said Stephanie, who is 36.
Bennett had made calls to get into a treatment facility but hadn't had much luck, running into common problems not necessarily addressed in the proposed legislation.
One obstacle: Bennett needed detox for the drinking, but several places were only equipped to treat her depression, Stephanie said.
Some places had no beds immediately available and offered help months down the road.
"She knew she needed more immediate help and more rigorous help than what they were even offering," said Stephanie.
So Stephanie called a place she thought was in Kansas City but turned out to be in Austin, Texas. The facility took Bennett's insurance information and told Stephanie that the insurance company pre-approved the request, she said.
That was on a Saturday.
"But on Monday (the facility) called me and said 'actually, the insurance did deny her because it was out of state,'" Stephanie said.
One of the two most commonly used plans offered by Blue Cross is an Exclusive Provider Organization, or EPO, plan, the company says. It does not provide coverage for a doctor or hospital outside a 103-county service area. It does not provide out-of-network benefits.
The company's PPO -- Preferred Provider Organization plan -- has a larger in-network coverage area that extends beyond the Kansas borders, the company said. It's not known which plan Bennett had.
Stephanie made more phone calls and got more frustrated. One place told her that Bennett could pay out-of-pocket for the treatment her plan didn't cover, costing at least $12,000, Stephanie said.
"It was kind of damned if you do, damned if you don't," said Stephanie. "She couldn't get out-of-state (treatment) and she couldn't get in-state. ... I was stunned at the runaround I got. My jaw was on the floor at the first phone call."
$6,000 in ER bills
Stephanie said her sister began feeling as if facilities were turning her down because her crisis wasn't serious enough, but she doesn't know which facilities said that.
In its statement, Blue Cross said it "does NOT require someone to be in an 'emergency' state to be able to receive mental health services. A member may seek outpatient or inpatient care with a mental health provider or facility through the appropriate network as required by their plan.
"They may also seek help at an emergency department when other services are not available or the member is in urgent need of mental health care."
Stephanie said her sister didn't want to go the ER.
"She still had probably $6,000 worth of ER bills to pay. ... She had had two separate instances of grand mal seizures (because of her meds). They had taken her to the ER each time and she begged me not to take her to the ER," she said.
"She was stressed about the money, everything she owed still. So that's what we were working on, was getting her inpatient treatment without going to the ER first."
That Thursday night, two days after she would have boarded a plane to Austin, Bennett took pills while her sister slept nearby.
"I want her back, that's what I want," said Stephanie. "But this (bill) isn't going to do that. So I guess the next best thing would be for it to not happen to somebody else, or happen over and over again to everybody else.
"I don't know how to do that. I don't know how to accomplish it."
Though Bennett was cremated, her mom still wanted a headstone at the cemetery. To decorate it, she picked a photo from among the dozens of photos Cook had taken of her sister over the years.
In it, Bennett is a teenager, sitting on the bright green lawn of Osawatomie State Hospital nearby. The sun behind her created a halo effect around her head.
As she looked at that old photo last month, something dawned on Cook.
Osawatomie was one of the places that turned her sister down at the end.
To get help
If you or someone you know has suicidal thoughts, call the National Suicide Prevention Lifeline at 800-273-8255.
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