Mental Care Is Covered
September 22, 2012
By AVERY FORMAN
Coping with a mental-health condition can be daunting and costly, but a recent law is aiming to ease the burden.
As of last year, some health plans that offer mental-health and addiction coverage are required to offer it at an equal level to the medical coverage they provide. That means no limits on the number of visits per year to a psychiatrist, for instance, if there aren’t such limits on visits to, say, an oncologist.
The Mental Health Parity and Addiction Equity Act is an updated version of a 1996 law that was passed in 2008, and most insurance plans were required to be compliant with it in 2011. Many Americans don’t know it exists, however. According to a survey by the American Psychological Association, 89% of Americans had not heard of the law.
But knowing your rights under this law could help you deal with your doctor, hospital, pharmacist and insurance provider should you need care for a psychiatric problem. Realizing that treatment might be covered could encourage more Americans to seek care in the first place, advocates say,
which could cut down on the cost of an unmanaged psychiatric problem in the long term.
Mental-health care is a huge financial strain on the health-care system and on individual families. More than half of the respondents to the American Psychological Association’s survey said the cost of mental care would deter them or a family member from seeking treatment.
Under the mental-health parity law, copays and deductibles are supposed to be the same as for other types of health care, and out-of-network coverage is required if non-network providers are covered for medical and surgical procedures.
The first thing to do is check that your plan covers mental health and substance abuse. The law doesn’t require it to, nor does it require your provider of choice to contract with your insurer.
“I don’t know if the fancy places will show up in the network,” says Karen Pollitz, senior fellow at the nonprofit Kaiser Family Foundation.
The law also is applicable only to so-called large group policies—those taken out on behalf of 50 or more people. So if you are at a small company or have individual coverage, you are unlikely to benefit from new protections.
That is likely to change, in part, in 2014. That’s when, under the Affordable Care Act, such plans will have to cover an essential set of services, including mental health and substance abuse.
“You’ve got to pay attention to where you are getting coverage,” says Ms. Pollitz.
Patients who stand to benefit the most are heavy users of mental-health care who have run up in the past against inpatient and outpatient limits—typically 20 inpatient and 30 outpatient days.
“The law has been enormously helpful for patients whose disorder is on the severe end of the spectrum,” says Andrew Sperling, director of legislative advocacy at the National Alliance on Mental Illness. “A mild anxiety disorder is unlikely to need 20 inpatient hospital days a year.”
Another tip is to try working with your primary-care provider first. The parity law has made providers more willing to address mental-health needs, whereas some used to “shy away from it,” says Elias Shaya, chief of psychiatry at MedStar Good Samaritan Hospital in Baltimore. “Now they are becoming much more proactive, because they recognize the value of treating [a condition such as] depression early.”
Once you know your rights, you can fight for coverage. Resources include parityispersonal.org, a site with resources and instructions on filing a complaint that is run by a coalition of groups. HealthCare.gov, a site that explains the reform law, also contains useful links.