Happy New Year for 2012, and all that January brings: fair-weather dieters, exercise equipment sales, and inevitable changes in insurance plans that take effect as the ball drops in Times Square.
This year may bring to many of your patients substantial changes in coverage for mental health services reflecting, at long last, the changes implemented by the federal Wellstone-Domenici Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008.
By Betsy Bates Freed, Psy.D.
Although its provisions technically went into effect on Jan. 1, 2011, insurance plans were not required to implement MHPAEA until the onset of a new health plan year, following open enrollment periods that occurred, for most companies, in the fall of 2011. New cards, along with an inevitably complex description of changes to mental health benefits, have just arrived.
In a nutshell, what mental health parity means for most patients:
Benefits for mental health services that are at least equal to those offered for medical diagnoses
An end to pre-approval for a set number of visits to a psychologist or other mental health professional, unless such pre-approval is also required for visits to physicians
Equal deductibles, co-pays, and maximum out-of-pocket thresholds for medical and mental health services
Coverage of out-of-network mental health provider services on par with those offered for out-of-network medical providers
Previously, many people with employer-sponsored benefits could access mental health care and/or substance use treatment, but only after receiving pre-approval to see a provider on the panel of a "carved out" plan. The approval would permit only a certain number of visits, say, once weekly sessions for 15 weeks, and only for certain diagnoses. Quite often, co-pays were high and visits were capped for an individual over the course of a calendar year.
Such limitations, in my opinion, were unfair and unwise. To illustrate the point, an analogous plan for medical benefits would have started the clock ticking on a patient if he visited a pre-approved doctor in January for diabetes care, and then only pay for 15 visits (one per week), no matter whether his blood sugars were under control, he had an exacerbation of the condition, or he was unlucky enough to also get influenza late in the year.
By failing to cover certain diagnoses altogether, and sharply limiting coverage of others, token mental health insurance plans erected financial barriers to patients savvy enough to recognize that they needed help to get through a clinical depression, a series of panic attacks, or a profoundly difficult life event, such as a new or recurrent diagnosis of cancer.
Of course, many community and regional health centers, as well as local chapters of the American Cancer Society, offer no- or low-cost psychological support to cancer patients and their families in the form of support groups, and in some cases, individual, couples, and family counseling services.
However, constricting budgets have reduced such offerings in many places, and some patients and families simply need more intensive psychological assistance than these donation-supported programs can provide. Some cancer centers are shifting to billing insurance companies for mental health services for patients who have coverage.
The political fight for mental health parity spanned years and sought to banish longstanding inequities in employer benefit packages that often treated mental health coverage as a bedraggled stepchild relegated to the back of the insurance card.
The philosophy behind parity reflected a heightening awareness of the connections between mind and body, the tangible benefits to overall health of improved treatment of psychological and substance use disorders, and the harm done by continued stigma associated with mental health treatment.
As with most political footballs, this one was kicked around quite a bit before the change was finally enacted as the result of bipartisan cooperation that today would be impossible. Nonetheless, it contained – surprise! – massive loopholes.
For example, the federal law does not cover people with individually purchased insurance policies or group health plans for companies with fewer than 50 employees. It does not require employers to offer mental health coverage, only requiring parity if both medical and mental health benefits are included in a plan.
As summarized by the American Psychological Association, the federal changes will supersede state parity laws when the federal provisions are stronger.
The provisions of the MHPAEA aren’t perfect, to be sure. However, in that they balance medical and mental health coverage for employees of the nation’s largest, bellweather companies and begin to chip away at stigma-based barriers to the overall health of Americans, they’re certainly a start.
And I’ll make a New Year’s toast to that.