We recently received an email from The Law Firm of Kanter & Kanter with a legal news update about Mental Health and Obamacare. We wanted to share with you what they found! Below is the update on Mental Health Equality and if it’s working under Obamacare.
*This legal news update belongs to The Law Firm of Kanter & Kanter distributed in their newsletter. To sign up for their newsletter here. All rights and credibility belong to The Law Firm of Kanter & Kanter. Inner Door Center did not contribute to this update.
Mental Health Equality Under Obamacare: Is it Working?
According to a new survey conducted by the National Alliance on Mental Illness (NAMI), many insurance companies are failing to provide adequate mental health coverage under Obamacare. Although President Obama’s health care law has helped an estimated 62 million people access health care, policies still have a long way to go before making a significant difference in the lives of those with mental illness.
What do we need?
What we need and deserve is the opportunity to access the right treatment, at the right time, in the right setting. Unfortunately, insurance companies continue to fall short in meeting these basic needs while consistently finding ways to evade mental health parity laws. Barriers are set into place immediately for those seeking insurance coverage for mental health care. Many people experience delays and difficulties when seeking treatment, limitations in types of treatment, limitations in geographic location of treatment, or outright insurance denials. For some, these obstacles become too overwhelming to manage. Any of these barriers can be a reason to say, “Never mind, I give up. This is too hard.”
What are the issues?
The Mental Health Parity Act (MHPAEA), enacted in 2008, requires that mental health benefits be provided on the same terms as medical/surgical care. This ground-breaking law applies to employer-sponsored health plans with more than 50 employees, including self-insured and fully insured plans. The Patient Protection and Affordable Care Act of 2010 (ACA) strengthened parity requirements by extending federal parity requirements to individual and small group plans. Additionally, mental health and substance use disorder services were mandated as one of ten categories of “Essential Health Benefits” required for all plans sold though the federal health insurance marketplace, or state exchanges (NAMI). These laws indicate a huge step forward in the fight for mental health parity and mental health inclusion in insurance policies. However, the definition of parity remains elusive, allowing insurance companies to craft their own interpretations and definitions for coverage. In their survey, NAMI evaluated the experiences of those living with mental illness (and their families) with private health insurance. The following issues were reported:
▪ Serious problems in finding mental health providers in health insurance plan networks;
▪ High rates of denials of authorization for mental health and substance use care by insurers;
|▪ Barriers to accessing psychiatric medications in health plans;|
▪ High out of pocket costs for prescription drugs that appear to deter participation in both mental health and medical treatment;
▪ High co-pays, deductibles and co-insurance rates that impose barriers to mental health treatment;
▪ Serious deficiencies in access to information necessary to enable consumers to make informed decisions about the health plans that are best for them in ACA networks.
What can we do?
Enforcement: Achieving true parity in accessing mental health care places a great deal of responsibility on us as a community (healthcare providers, advocates, patients, lawmakers etc.). It means staying vigilant and holding insurance companies accountable for their actions. Achieving true parity means continuing to challenge unfair mental health insurance denials and continuing to fight for equal access to mental health care.
Transparency: Insurers should be required to publish the clinical criteria they use to approve or deny care. In our office, we see countless insurance denials for eating disorder treatment. Insurers often use ambiguous language when referring to internal guidelines for coverage. For example, we often see insurers deny coverage claiming that a patient isn’t making enough progress, so they must step down to a lower level of care. In reality, according to American Psychological Association guidelines, when a patient isn’t making enough progress, they may need to step up to a higher level of care. We see things like, “your eating disorder is not medically necessary,” “your eating disorder is chronic and therefore cannot be treated,” or weight based denials such as “your weight is now stable and you do not need residential treatment.” These seemingly nonsensical decisions are made by insurers every single day, hindering access to life-saving mental health treatment. We need greater transparency from insurers on how these decisions are being made.
Furthermore, health plans should be required to publish accurate lists of providers, including mental health providers, participating in plan networks and to update those lists regularly. This information should be easily accessible to everyone.
Although both MHPAEA and ACA have paved the path to parity and equal access to mental health care, the road ahead remains long and complicated. Much work remains before we all understand parity in the same way, before access to mental health care is smooth and seamless, before discrimination and stigma in mental health care is eliminated.
At Kantor & Kantor, we continue to fight unfair insurance denials and challenge parity violations so that our clients can have access to the life-saving treatment that to which they are entitled.
If you have experienced a mental health related insurance denial, or have been denied coverage for the treatment of an eating disorder, please do not hesitate to contact our office for a no-cost consultation.
We understand, and we can help.