By law, many U.S. insurance providers that offer mental health care are required to cover it just as they would cancer or diabetes care. But advocates say achieving this mental health parity can be a challenge. A report released earlier this week by the National Alliance on Mental Illness found that “health insurance plans are falling short in coverage of mental health and substance abuse conditions.”
Reporter Jenny Gold of Kaiser Health News tells NPR’s Arun Rath that patients are still having trouble getting their care covered. In this interview, she outlines some of the issues confronting both patients and the insurance industry.
Currently, insurers adhering to parity rules is a mixed bag.
Insurance companies used to have a separate deductible or higher copay for mental health or substance abuse visits. That’s sort of gone away. For the most part, insurers really have complied. Right now, there really isn’t a separate deductible for mental health and there isn’t a higher copay, so on that side, you know, they really have complied. But on another sort of subtler and harder-to-pinpoint side, advocates are saying they’re really not complying.
Insurance companies, in order to keep down costs, they will do things called “medical necessity” review. Basically, they look at someone’s care and ask is it really medically necessary. And advocates say they’re applying those sorts of cost-control techniques way more stringently on the mental health side and the substance abuse side than they are on the physical health side. So people are still having trouble getting their care covered.
Insurers say it’s complicated to distinguish between physical and mental health
Insurance companies are arguing this is a really hard law to implement. I spoke with Clare Krusing from America’s Health Insurance Plans, which is the insurance industry’s main trade group, and she says they’re really doing their best to make this work:
“The plans have taken tremendous steps since the final rules came out to implement these changes and requirements in a way that is affordable for patients and again this goes back to the fact that we are at a point where health care costs continue to go up.”
She also said that it’s hard to compare mental and physical health, that those are two really different things, sort of apples and oranges, and it’s hard to make them exactly equal when treatment often doesn’t line up and success can be harder to measure on the mental health side.
Patients still report ongoing challenges
Advocates, patients, lawyers alike say it’s not going well for patients and that we’ve got something that looks like mental health parity in name only. The National Alliance on Mental Illness polled their consumers and found out that consumers said they were twice as likely to get their mental health care denied than medical care, which suggests that insurance companies still aren’t sort of judging whether care ought to be given equally between the two.
I spoke with Carol McDaid, an advocate who runs the Parity Implementation Coalition. She’s got a helpline where she takes consumer complaints from people who say they’re still having trouble getting their care covered:
“They end up with this perception that they have access to care, but when they’re in a crisis for themselves or their loved one, lo and behold, the care’s not available because of these cost-control techniques.”
It’s really hard for people to bring a complaint. In order to prove there’s been a violation, you actually have to look at how an insurance company makes decisions on the mental health side and then compare it to how they make determinations on the medical, surgical side. And insurance companies aren’t even willing often to give up those documents to be analyzed.
In addition, for a consumer to make a complaint, it means they have to come forward and admit on some level that they have a mental illness. There’s still a lot of stigma about these conditions and sometimes it’s hard for people to step forward. Especially when it means telling their employers that they have some kind of illness.
A few states are taking action
There are a handful of states that really are taking some enforcement actions, including New York, which has made some settlements with insurance companies, and California — and also, quite a few individual and class action lawsuits against insurance companies alleging that they are violating mental health and substance abuse parity law. And so that may end up being the way it sort of starts getting enforced.