Have you ever sought mental health care for your child? What about care for a drug addiction? Have you made calls to multiple providers on your health insurer’s “list” and had the door slammed repeatedly in your face? Or were you fortunate enough to make a good connection and then unceremoniously have the rug pulled out from under you, with your insurer denying continued care?
Welcome to the club.
If you have a child with a mental health or addiction problem, you know how hard it is to make that first phone call. A parent with a child with cancer doesn’t hesitate to call for help. But when mental health is the problem, it can take weeks, months or even years because of the crippling effect of stigma. But what about the two situations I described above: You make that call, but you are denied continued care or you’re denied access to care in the first place?
The federal parity law, formerly known as the Mental Health Parity and Addiction Equity Act, is designed to prevent group health plans and health insurance companies from imposing less favorable benefits than they do for other medical conditions. The law is supposed to guarantee that people with mental illnesses have the same access to treatment as patients with diseases like diabetes, but some insurers have continued to limit treatment in subtle ways.
According to a recent report by NPR, since 2010, the United States Department of Labor, which is the main federal agency in charge of parity, has found 140 instances in which a patient’s parity rights were violated. Although all those issues were resolved voluntarily, no insurer has been fined and none of the results are public.
Regarding gaining access to care in the first place, network adequacy refers to a health plan’s ability to deliver the benefits promised by providing reasonable access to a sufficient number of in-network primary care and specialty physicians, as well as all health care services included under the terms of the contract. The reality is that, because private insurers pay substandard rates as compared to Medicaid, middle class families are finding it harder and harder to find providers to help their children. They look at their insurer’s list of providers, make phone calls and are repeatedly told, I’m sorry, I don’t accept your insurance. The lists are inadequate, outdated or just plain falsehoods.
On July 22, 2015, Assemblyman Todd Kaminsky authored a letter to the New York State Department of Financial Services (DFS) to express deep concern about the lack of commercial insurance coverage for mental health services for middle class families on Long Island. He requested that DFS launch an investigation to determine the scope of this pressing problem.
Assemblyman Kaminsky said, “After hearing from numerous constituents and closely studying this issue, it is clear that commercial insurance companies do not have adequate mental health service networks for hard-working families. This lack of access to care is alarming, and I hope DFS will immediately respond by commencing a thorough study of this issue.”
While Medicaid covers comprehensive mental and behavioral health services, commercial insurance frequently does not provide coverage, or if they do, the rates are miniscule compared with the cost of treatment. The reality today is that fewer community-based mental health clinics are accepting privately insured clients who earn too much to qualify for Medicaid, which leaves these families with nowhere to turn for affordable care. They have few options to access care for their children, even those experiencing life-threatening crisis situations.
By ignoring the enforcement of the federal parity law, the majority of representatives in government are turning their backs on the millions of Americans who are in need of essential mental health care services. We cannot trust insurance companies, whose eye is on their bottom lines, to do the right thing. It’s no exaggeration to say that lives have been and will continue to be lost unless we pressure our politicians to make this a top priority.
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