Mental health problems like anxiety and depression are conditions that need and benefit from treatment. However, for years, many patients who received treatment for depression or alternative ailments through group health insurance plans were frequently saddled with greater out-of-pocket expenses than they might have been for other types of illnesses.
“In a lot of cases, health plans did have higher copays for mental health services or lower limits on how many visits you may make to an outpatient provider or a reduced number of in-patient days,” says Kirsten Beronio, vice president for public policy and advocacy at Mental Health America, a non profit organization that promotes mental wellness.
A new law, nevertheless, may help some individuals receive more fair insurance plan for depression as well as other mental health difficulties. The Mental Health Parity and Addiction Equity Act of 2008, that was passed in the fall of that year, requires group health insurance plans to have benefits for substance abuse disorders and mental health that are equivalent to the coverage provided for other types of medical problems.
Health plan years commencing after Oct. 3, 2009 are now subject to the new regulations. But since most plan years work with a calendar basis, most plans did not become compliant until the beginning of 2010. “That is the actual beginning date for this,” Beronio says.
Depression Treatment: How the New Law Works
The Mental Health Parity and Addiction Equity Act can help patients needing treatment for depression symptoms or other mental health conditions in these manners:
- Equitable copays and deductibles. Under the new law, patients who see a doctor for depression symptoms can not be charged a higher co pay or be saddled with a higher deductible than they would if they sought treatment for, say, the flu. An addition to the law released in February 2010 says that patients can’t be billed treatments or separate deductibles for depression treatment for other mental health ailments. “There was some question regarding whether you may possess a separate but equivalent deductible for substance abuse and mental health problems versus other conditions,” Beronio says. “But in this rule, they say no — it can’t be separate because that imposes a larger burden for folks who need those services.”
- Out-of-network benefits. If a group health plan covers clinical and surgical treatments by out-of-network doctors, it should also cover mental health and substance abuse treatments by out-of-network doctors. Before, some health plans didn’t cover such out-of-network treatment, so patients who wanted to see a doctor beyond their plan’s network for mental health reasons had to buy their care themselves, Beronio says. Now, it can be less difficult to get coverage for visits to out-of-network physicians.
- Fair treatment limitations. If a plan imposes yearly or lifetime dollar limits on medical and surgical benefits, those same limits must apply to mental health and substance abuse benefits. (The Mental Health Parity Act of 1996 enforced this rule for mental health coverage; the new regulations expand the protection to substance abuse coverage.) If you reached the dollar limit of your strategy in previous years, you may find that roadblock is now lifted.
- More tips for consumers. Group health plans are actually required to disclose the standards they use to make decisions as to whether mental health and substance abuse treatments are medically necessary. Should they refuse coverage for a specific treatment, increasing their liability to members, the plans must also give a motive.
There are some limits to the newest rules. Group health insurance plans for companies who have 50 workers or less are not subject to the regulations that are brand new. Insurance plans that are bought on the private marketplace are exempt too. “In case you are an individual purchasing your own insurance, this does not apply to you,” Beronio says.
It’s also very important to see that the new law does not require health insurance plans to cover The National Conference of State Legislatures.
Finally, employers may submit an application for exemptions to the new laws when they can prove that the requirements have caused their total plan prices to rise by more than 2 percent following the enactment of the law throughout the first year and by 1 percent each year thereafter. Nevertheless, companies must first implement the brand new laws for at least six months. “They would have to demonstrate that using licensed actuaries, along with the exemption will only last for one year,” Beronio says. “There’s still not a lot in the regulations on that, and also the authorities will be issuing more guidance in the longer term.”
They were opened up to public comments so some minor ambiguities in the text of the law may change, after the clarifications to the laws were released in February. But, the important provisions of the regulations are likely to stay.
Beronio thinks the brand new parity laws will go a ways toward helping get treatment for individuals who are depressed or who have other mental health disorders. “In general, we are pretty pleased,” Beronio says. “I believed the regulations did a great job of trying to think of the different ways [in which] mental health and substance abuse coverage happen to be discriminated against.”