Let’s start first with a little historical background. While a law to change the way insurance companies reimbursed for mental health treatment was passed years ago, the Mental Health Parity and Addiction Equity Act of 2008; the rules to carry it out was not passed until November 2013 under the Affordable Care Act – ACA, known informally as ‘Obamacare.’ The 2008 law stated that if insurance companies provided coverage for mental health treatment, the coverage had to be the same as for physical ailments (that’s what ‘parity’ means). For example, insurance plans could not set higher deductibles or charge higher co-payments for mental health visits than for medical visits. They also couldn’t set more restrictive limits on the number of visits allowed. What this law didn’t do, was include mental health care and substance abuse treatment as an ‘essential’ benefit, meaning that all insurance plans sold on public exchanges did not have to include this coverage. This is the second major step taken by the ACA – mental health care and substance abuse treatment are now considered ‘essential services’.
Many insurance plans already comply with certain aspects of parity. What will be new to many plans, however, is the requirement that insurance cover what is called ‘intermediate’ treatment options like residential treatment or intensive outpatient therapy (IOP). There is also a requirement that getting approval for inpatient mental health treatment can’t be more difficult than admission requirements to acute medical care hospitals. Patients and doctors must be told what criteria will be used to make those inpatient decisions. This can be helpful if coverage is denied and a patient wants to file an appeal.
Despite these changes, you still need to be an educated consumer. If you think your plan isn’t following these rules, you need to ask questions. A tool kit to help you file an appeal can be found at parityispersonal.org. You can also contact your plan administrator to find out more information about how to proceed with your concerns.
It’s also important to realize that many office-based psychiatrists do not accept any insurance, partly because the reimbursement for services has been so inadequate. To find a therapist who does accept your insurance, you can contact your insurance company to ask for a list of the providers in your area. You can also reach out to your county behavioral health department which coordinates mental health care and can help you find affordable treatment. The federal Substance Abuse and Mental Health Services Administration (SAMSHA) also offers a service locator on its website
(Source: Carrns, A . Understanding new rules that widen mental health coverage. New York Times, January 11, 2014, p. B4)