Survey: Coverage for Mental Health Care Still Trails Coverage for Physical Care

New research from the National Alliance on Mental Illness shows that insurance companies are failing to provide adequate coverage for mental health and substance abuse services, compared with coverage for physiological care.

People with mental health and substance abuse disorders have long faced barriers to getting sufficient healthcare, a problem perpetuated by a deep-rooted bias toward treating physiological disorders over mental ones, advocates for better mental health services say.

Objections to that inequity led to passage of the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA), which requires that insurance benefits for treatment of mental illness and substance abuse are equal to those for physical healthcare. This means that residential care, emergency care, prescription drugs, and other benefits and services must be equal in quality and accessibility, whether a patient has schizophrenia or diabetes.

However, a new report [PDF] from the National Alliance on Mental Illness suggests that insurance equity has yet to become a reality.

Despite the law, discrimination still exists toward mental health and substance use conditions.

“Despite the law, discrimination still exists toward mental health and substance use conditions,” NAMI Executive Director Mary Giliberti said in a statement. “Progress is being made, but there is still a long road ahead. NAMI’s report identifies areas where insurance companies need to improve and greater scrutiny is needed.”

NAMI surveyed 2,720 people with mental illness and their families with private health insurance. The organization also analyzed 84 existing health plans in the top 15 states by projected 2014 exchange enrollment.

Challenges Highlighted

The report indicates that patients in need of mental health and substance abuse services, collectively referred to as behavioral health services, must cut through a mass of red tape to find appropriate health professionals or programs—if there are any available. These patients also face high treatment costs and often lack the necessary information to make informed decisions about their healthcare.

According to the report, 29 percent of respondents had been denied mental health care on the basis of medical necessity. Eighteen percent had been denied substance abuse care, and 14 percent were denied general medical care. Additionally, more than half of the health plans covered fewer than 50 percent of analyzed antipsychotic medications.

Clare Krusing, a spokeswoman for America’s Health Insurance Plans, said insurance companies are working toward providing ample coverage for behavioral health services.

“The [health] plans have made tremendous steps since the final rules have come out to implement these changes and requirements in a way that is affordable for patients,” Krusing told Kaiser Health News. “And again this goes back to the fact that we are at a point where healthcare costs continue to go up.”

Next Steps

In light of the survey results, NAMI made several policy recommendations to ensure that the MHPAEA is strongly enforced. The association called on insurers to publish the criteria they use to approve or deny care and asked them to publish accurate lists of healthcare providers, including those for behavioral health services.

The Department of Health and Human Services should require that health plans provide clear, easy-to-understand, and accessible information for patients, NAMI said. It also urged Congress and the White House to cooperate in decreasing out-of-pocket costs under the Affordable Care Act for low-income consumers.

“Achieving true equity in accessing mental health and substance use disorder care requires vigilant attention by advocates and public agencies responsible for enforcement,” NAMI said in a statement. “Our findings reveal that while progress is being made in law, we have a long way to go to achieve true parity in mental health and substance use care.”


Julia Haskins

By Julia Haskins

Julia Haskins is a contributor to Associations Now. MORE

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