Insurance Coverage of Mental Illness

With a nation still mourning the Newtown mass shooting and on going concerns of what appears to be an epidemic currently taking place in our country, now more than ever before, mental illness is being discussed and addressed as a serious issue.  While the conversation may start with the causes and factors that may lead to such insipid crimes and mental instability, we'll never be able to prevent all mental illness. It's a complex, long term problem that will take years and years of study and reform in how we think and operate as a society.  For the immediate future, the quickest and easiest fix for those with mental struggles is to consider improving treatment through proper care and insurance coverage.

For too long, the health insurance industry has virtually ignored the pressing need for increased coverage and access to mental health care.  One of my Claims Security of America client's who's self employed, and maintains a traditional individual policy through Blue Cross Blue Shield of Florida, has mental health coverage that only allows for 8 visits to a Psychiatrist or Psychologist a year. 8 times in 365 days! That's hardly enough time for any sort of real treatment or help should he need it. What makes even less sense if that he was under a group's insurance plan with more than 50 employees which covers mental illness and treatments, then he'd have no coverage limits as required under the Mental Health Parity and Addiction Equity Act.  Naturally, insurers profit more from indemnifying a group verse an individual; but you could argue a self-employed person is under far more stress and more susceptible to mental health care than someone who's in a full-time position with full-time benefits, and thereby needs the extended coverage even more.

In 2008 Congress passed the Mental Health Parity and Addiction Equity Act, which went into effect Jan. 1 of 2010, but this set of laws still only affected group health plans with more than 50 employees.  Under this law, insurance companies can no longer arbitrarily limit the number of hospital days or outpatient treatment sessions, or assign higher co-payments or deductibles for those in need of psychological services. However, the single self-insured is one again left out. http://www.apa.org/helpcenter/parity-law.aspx# 

Unfortunately, when the recession hit a few years ago, many states and communities made significant mental health care cuts.  ABC NEWS reports:

"Since the recession forced budget cuts in 2009, state general funding for mental health care has decreased by an estimated $4.35 billion nationwide, according to the National Association of State Mental Health Program Directors . . . "

According to The National Institute of Mental Health more than 54 million Americans suffer from sort of mental disorder in any given year. That's roughly 1 in 4 of us. One in 17 people suffer from a "serious debilitating mental illness." An authoritative 2005 study suggested more than half of all Americans, will at some point, experience a major psychiatric disorder or substance abuse in their lifetime. In short, mental instability is the most common struggle we face.  Here's some warning signs to look out for and how to cope with them.

http://www.nmha.org/go/information/get-info/mi-and-the-family/recognizing-warning-signs-and-how-to-cope

Beginning in 2014 the Affordable Care Act (Obamacare) will require that all health insurance plans for small employers (less than 50 employees) and individuals include coverage for mental health and addiction.  Also, states that agree to expand Medicaid under the ACA will make the federal health insurance program's mental health coverage available to more low-income people. In addition, the ACA allocates money to increase the number of mental healthcare professionals across the country. The New York Times offers more detail on Obama's expansion of mental health care.

http://www.nytimes.com/2012/07/10/health/policy/health-care-law-offers-wider-benefits-for-treating-mental-illness.html

Help is on the way, but much more is still needed.  The World Health Organization ranks depression as the world's leading cause of disability. And if you've ever been even slightly depressed, you're well aware of how paralyzing it can be. Until we, as a society, accept mental illness as a disease every bit as life threatening as cancer, real progress will never be made

We know Congress has a full plate already, but nothing is ever solved overnight. Mental health is finally getting the attention it warrants and let's hope we begin to see benefits that work for all of us, not just some of us.  Parity means equal coverage for both mental health and physical health conditions.  Discriminating between group coverage greater than 50 employees, other small groups under 50, as well as individuals, does not conform to the definition of parity. But as long we continue to engage in these kind of discussions,  hope for a better future for all of us seems brighter.

Stay Positive, Stay Informed, Stay Healthy
- The Patient's Advocate