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Health Insurance Agent Quotes - Health Insurers Are Still Skimping On Mental Health Coverage
Health Insurance Agent Quotes - Health Insurers Are Still Skimping On Mental Health Coverage
A coalition of mental health advocacy groups is calling on federal
regulators, state agencies and employers to conduct random audits of
insurers to make sure they are in compliance with the federal Mental
Health Parity and Addiction Equity Act of 2008.
It has been nearly a decade since Congress passed the Mental Health Parity And Addiction Equity Act,
with its promise to make mental health and substance abuse treatment
just as easy to get as care for any other condition. Yet today, amid an
opioid epidemic and a spike in the suicide rate, patients are still
struggling to get access to treatment.
That is the conclusion of a national study published Thursday
by Milliman, a risk management and health care consulting company. The
report was released by a coalition of mental health and addiction
advocacy organizations.
Among the findings:
- In 2015, behavioral care was four to six times more likely to be provided out-of-network than medical or surgical care.
- Insurers paid primary care providers 20 percent more for the same types of care than they paid addiction and mental health care specialists, including psychiatrists.
- State statistics vary widely. In New Jersey, 45 percent of office visits for behavioral health care were out-of-network. In Washington, D.C., it was 63 percent.
The
researchers at Milliman examined two large national databases
containing medical claim records from major insurers for PPOs —
preferred provider organizations — covering nearly 42 million Americans
in all 50 states and D.C. from 2013 to 2015.
"I was surprised it was this bad. As someone who has worked on parity
for 10-plus years, I thought we would have done better," says Henry
Harbin, former CEO of Magellan Health, a managed behavioral health care
company.
"This is a wake-up call for employers, regulators and
the plans themselves," Harbin says, "that whatever they're doing,
they're making it difficult for consumers to get treatment for all these
illnesses. They're failing miserably."
The high proportion of
out-of-network behavioral care means patients with mental health or
substance abuse problems were far more likely to face the high
out-of-pocket costs that can make treatment unaffordable, even for those
with insurance.
In its statement issued with the report, the
coalition of mental health advocacy groups, which included Mental
Health America, the National Association on Mental Illness and The
Kennedy Forum, called on federal regulators, state agencies and
employers to conduct random audits of insurers to make sure they are in
compliance with the parity law.
Harbin, now a consultant on
parity issues, said the report's finding that mental health providers
are paid less than primary care providers is a particular surprise. In
nine states, including New Hampshire, Minnesota, Vermont, Maine and
Massachusetts, payments were 50 percent higher for primary care
providers when they provided mental health care.
Because of low reimbursement rates, Harbin said, professionals in the
mental health and substance abuse fields are not willing to contract
with insurers. The result is insurance plans with narrow behavioral
health networks that do not include enough therapists and other
caregivers to meet patient demand.
For years, insurers have
maintained that they are making every effort to comply with the 2008
federal mental health parity law, which was intended to equalize
coverage of mental health and other medical conditions. And previous
research has found that they have gone a long way toward eliminating
obvious discrepancies in coverage. Most insurers, for example, have dropped
annual limits on the number of therapy visits that they will cover.
Higher co-payments and separate deductibles for mental health treatment
have become less of a problem.
Still, discrepancies appear to continue in the more subtle ways that insurers deliver benefits, including the size of provider networks.
Kate
Berry, a senior vice president at America's Health Insurance Plans, the
industry's main trade group, says the real problem is the shortage of
behavioral health clinicians.
Health plans are working very hard to actively recruit providers and
offer telemedicine visits in areas with shortages, says Berry. "But some
behavioral health specialists opt not to participate in contracts with
providers, simply because they prefer to see patients who are able to
pay out of their pocket and may not have the kind of severe needs that
other patients have."
"This is a challenge that no single stakeholder in the health care infrastructure can solve," she adds.
Carol
McDaid, who runs the Parity Implementation Coalition, counters that
insurers have been willing and able to solve provider shortages in other
fields. When, for example, there was a shortage of gerontologists,
McDaid says, insurers simply increased the rates and more doctors joined
the networks.
"The plans have the capacity to do this," she says. "I just think the will hasn't been there thus far."
The
scarcity of therapists who accept insurance creates a care landscape
that is difficult to navigate for some of the most vulnerable patients.
Ali
Carlin, 28, says she used to see her therapist in Richmond, Va., every
week, and had a co-payment of $25 per session. But in 2015, the
therapist stopped accepting her insurance and her rate jumped to $110
per session.
Carlin, who has both borderline personality
disorder and addiction problems, says she called around to about 10
other providers, but she couldn't find anyone who would accept her
insurance and was taking new patients.
"It's such a daunting
experience for someone who has trouble maintaining their home and
holding a job and friendships," says Carlin. "It makes me feel like no
one can help me, and I'm not good enough and it's not an attainable
goal."
In Virginia, the Milliman report found that 26 percent
of behavioral health office visits were out-of-network — more than seven
times more than for medical care.
With no alternative, Carlin
stuck with her old therapist but now has to save up between sessions.
She has just enough to cover a visit once every few months.
"I
make $30,000 a year," Carlin says. "I can't afford an out-of-pocket
therapist or psychiatrist. I just can't afford it. I'm choosing
groceries over a therapist."
Angela Kimball, the director of
advocacy and public policy at the National Alliance on Mental Illness,
says she worries many patients like Carlin simply forgo treatment
entirely.
"One of the most common reasons people give of not
getting mental health treatment is the cost," Kimball says. "The other
is not being able to find care. It's hurting people in every corner of
this nation."
source : https://www.npr.org/sections/health-shots/2017/11/29/567264925/health-insurers-are-still-skimping-on-mental-health-coverage
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