Mental health parity bill in the bailout

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It seems insurance companies will finally be required to cover mental health as they do physical illness. This mental health parity bill passed today as it was one of the additions to the economic rescue/bailout bill.

http://theboard.blogs.nytimes.com/2008/10/03/the-financial-bailouts-side-effect-on-mental-health/

I don't much about it beyond what I've read in brief news reports. Is this an entirely good thing as the media presents it?

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[Therapist4Chnge]

I completely disagree with the bail out, not to mention the long-standing practice of attaching flyers/pork to unrelated bills to get it approved.....but for once it actually benefited the general public. I remember a homeland defense bill that had a moralistic 'gambling is evil' flyer added to it as part of a horse-trade. The two bills were completely unrelated....and yet were passed through. Welcome to the good ol' US of A.

Anyone have more info about the Mental Health Parity Bill......I only know the basics and I am curious of the details.

 

[cara susanna]

I am completely against the bail-out too, but agree that at least some good things are coming out of it (that bill included).

 

[PsyDr]

before this bill insurance was able to pay less for mental health/ substance abuse services. now insurers are required to pay equally. So for example, previous to this bill a psychotherapy hour would require the patient to make a 20% copay, but the same insurance would only a 10% copay for something like a physical or lab work or whatever. now it will be 10%/10% for al things like copays, deductibles, coinsurance, out of pocket maxs, etc

also insurers can no longer deny coverage based solely on MH usage. which would presumably open up more health insurance to others who have previously been denied.

also the bill extends some benefits so that in network and out of network will be equitable.

 

[deleted176373]

+1 Against bailout and the associated pork. While I agree that the mental health parity was a reasonably good thing to address, I disagree with it being passed as stealth legislation. If it wasn't good to pass on it's own, it shouldn't have been part of this mess either. Don't get me on a rant, but I wish line item veto existed in this particular case.

Mark

 

[Pterion]

before this bill insurance was able to pay less for mental health/ substance abuse services. now insurers are required to pay equally. So for example, previous to this bill a psychotherapy hour would require the patient to make a 20% copay, but the same insurance would only a 10% copay for something like a physical or lab work or whatever. now it will be 10%/10% for al things like copays, deductibles, coinsurance, out of pocket maxs, etc

I wouldn't start the victory dance just yet. This will take a lot of looking into by people who truly have psychologists' best interests at heart. And by that I do not mean the APA. Or the APA.

also insurers can no longer deny coverage based solely on MH usage. which would presumably open up more health insurance to others who have previously been denied.

I would be very surprised if this is entirely true. It may or may not "open up more health insurance". One thing this bill does not do is require mental health coverage. It only requires that if it is covered, it is covered in the same manner as "medical" illnesses. As for denying coverage for usage: insurance can do that with any illness, not just MH. Lifetime maximums will likely decrease for everything. The coverage trough is a zero sum pool. There is not suddenly more money for this extra coverage. You can bet that this will cost somewhere else.

also the bill extends some benefits so that in network and out of network will be equitable.

This would be great, but again, there are many ways the insurance companies can get around this.

 

[psybee]

I would be very surprised if this is entirely true. It may or may not "open up more health insurance". One thing this bill does not do is require mental health coverage. It only requires that if it is covered, it is covered in the same manner as "medical" illnesses. As for denying coverage for usage: insurance can do that with any illness, not just MH. Lifetime maximums will likely decrease for everything. The coverage trough is a zero sum pool. There is not suddenly more money for this extra coverage. You can bet that this will cost somewhere else.

.

it is possible that it won't cost -- one of the arguments for parity was that untreated MI costs in many other ways -- increased somatic symptoms (and more Dr. visits and tests), interference w/ self-care, unhealthy behaviors (such as smoking, alcohol and drug abuse, etc) which can lead to serious health problems or exacerbate existing ones, and presenteesim and absenteesim at work. And SPMI, if left untreated, so often gets worse, so if an individual is allowed to deteriorate, at some point those very sick people will end up on government funds anyway, which ends up being way more expensive than the costs of early intervention.

 

[Pterion]

it is possible that it won't cost -- one of the arguments for parity was that untreated MI costs in many other ways -- increased somatic symptoms (and more Dr. visits and tests), interference w/ self-care, unhealthy behaviors (such as smoking, alcohol and drug abuse, etc) which can lead to serious health problems or exacerbate existing ones, and presenteesim and absenteesim at work. And SPMI, if left untreated, so often gets worse, so if an individual is allowed to deteriorate, at some point those very sick people will end up on government funds anyway, which ends up being way more expensive than the costs of early intervention.

Preaching to the chior. These longer-term costs, although completely real and of true societal impact, have little impact on the profit margins of 3rd party payors precisely because they end up on government funds. These costs aren't of importance to the insurance companies, and they couldn't care less about the societal costs writ large.

I think it's great that there is "parity". My concern is that the manifestation of "parity" will be very different from the concept promoted by psychology or suggested by the wording in the bill. Stay vigilant, I suppose is my point. Public education and professional self-advocacy is far from unnecessary right now.

 

[Therapist4Chnge]

Stay vigilant, I suppose is my point. Public education and professional self-advocacy is far from unnecessary right now.

I couldn't agree more....unfortunately I often wonder if the APA has the practicing Clinical Psychologists' best interests at heart. Compounding the problem is the NAPPP is far from ideal either. Maybe I should just scrap my clinical career and go into psych lobbying!

 

[PikminOC]

So how's that mental health parity working out in 2015?

 

[Baller MD]

So how's that mental health parity working out in 2015?

I too would like to know.

 

[erg923]

Word of the day is: Loopholes.

Phrase of the day: utilization review. Lots.

 

[smalltownpsych]

I felt that the whole concept of mental health parity is a failed strategy. It reminds me of my sister when she was 30 yelling at my mother, "You need to stop running my life." The truth is that we will get more accomplished when we continue to demonstrate that our treatments are cost effective and benefit the patient, insurance, and society. When we say that we need government to make people/corporations pay for our services, it makes them less likely to want to pay for our services. My experience has been that when patients want and need psychological services, the insurance companies tend to cover it. They know that it is a relatively inexpensive intervention and they also know that 8 to 10 sessions usually suffices and if you need more they jsut need to know that it is to prevent potentially more cost such as inpatient. Generally I find dealing with the private insurance companies to be more reasonable and effective than the government insurances. I also find that completely free services provided by medicaid, for example, to be less effective than when patient has some skin in the game.

 

[WisNeuro]

. My experience has been that when patients want and need psychological services, the insurance companies tend to cover it. They know that it is a relatively inexpensive intervention and they also know that 8 to 10 sessions usually suffices and if you need more they jsut need to know that it is to prevent potentially more cost such as inpatient.

That may be a minority experience. Back in my private days, most times our patients would not follow up with our mental health referrals due to insurance not covering, or making the deductible prohibitively expensive. Not too mention, most private insurers try to deny any npsych service they can if one of their reviewers deems in "medically unnecessary" i.e, doing a dementia evaluation and finding that it's just normal aging.

 

[smalltownpsych]

That may be a minority experience. Back in my private days, most times our patients would not follow up with our mental health referrals due to insurance not covering, or making the deductible prohibitively expensive. Not too mention, most private insurers try to deny any npsych service they can if one of their reviewers deems in "medically unnecessary" i.e, doing a dementia evaluation and finding that it's just normal aging.

I'm not saying that there aren't major problems with insurance companies. One of their favorite strategies is to make billing so complex that you just give up half the time. I just don't belive that the problems are that much different for us than other providers and even if they are, I don't think the parity strategy will help much. I would rather we pushed more for higher overall reimbursements for our services because they are of so much benefit.

 

[WisNeuro]

That would be great, but I would caution against quoting the party line that "anything government is bad," especially in terms of healthcare. Especially when, in what little healthcare outcome literature there is, the VA outpaces the private sector.

 

[smalltownpsych]

That would be great, but I would caution against quoting the party line that "anything government is bad," especially in terms of healthcare. Especially when, in what little healthcare outcome literature there is, the VA outpaces the private sector.

I thought the VA that I did a year-long practicum at did a pretty good job. I especially liked the way the psychological services were handled. I wasn't saying necessarily "gubmint bad" as opposed to mandating a fix for a problem that may or may not exist might be bad. Actually I think politicians tend to excel at getting elected to "fix big problems that may or may not exist". They love to do that with crime, too. Fear drives votes.

 

[WisNeuro]

Mayhaps, but we've seen that privatizing healthcare has not worked as some would lead us to believe. I would urge you to look at the US rank in quality of healthcare over the decades, and see what happens to our worldwide ranking after we privatize insurance? Notice a trend? Most of the top 10 rankings today are in countries that fully, or mostly, cover healthcare costs for every citizen. And, in spite of providing universal, high quality healthcare, they manage to only spend a fraction of the healthcare costs per capita compared to the US. I'm not sure the ACA has it completely right, but mostly private insurance sure wasn't cutting it either, by any measure.

 

[Therapist4Chnge]

Mayhaps, but we've seen that privatizing healthcare has not worked as some would lead us to believe. I would urge you to look at the US rank in quality of healthcare over the decades, and see what happens to our worldwide ranking after we privatize insurance? Notice a trend? Most of the top 10 rankings today are in countries that fully, or mostly, cover healthcare costs for every citizen. And, in spite of providing universal, high quality healthcare, they manage to only spend a fraction of the healthcare costs per capita compared to the US. I'm not sure the ACA has it completely right, but mostly private insurance sure wasn't cutting it either, by any measure.

Good idea in theory...but horrifically implemented. Too many loopholes. Too much red tape. Too restrictive. Too...Big Brother.

 

[WisNeuro]

Well, we can build on the theory in principle, or repeal and replace it with the old system. Sadly, I don't think we'll see any improvement anytime soon given the state of our dysfunctional government. More concerned with "winning" for their team than things that may actually help their constituents.

 

[smalltownpsych]

Sounds more like you are talking about ACA when the post is about mental health parity. When I first heard of it, I thought it sounded good and might help us. I don't think so now because a law doesn't increase our value and a law designed to do that has the opposite effect. A few years back an APA president was using dentists as an example of successfully increasing people's perception of their utility, thereby increasing utilization and compensation for their services. Typical dental insurance covers very little of this yet people pay for it because of successful marketing. I have never seen an APA ad campaign (outside the APA Monitor) promoting our services and how they lead to a better life for many wih minimal side effects. My point is that if psychologists look to the government to help our profession then we might as well hand over our jobs to the MA people who get paid half of what we do. Some of us might be happy since it means cheaper services for our clients. Maybe we could outsource the whole thing and people could get therapy at Walamart.

 

[WisNeuro]

Well, the ACA extends part of the MHP laws, so they are intertwined. Although, I think there is some kind of small business exemption for parts of it, so more loopholes.

Honestly, I would rather look to the government to help our profession than to private insurers. Lesser of two evils.

 

[smalltownpsych]

Well, the ACA extends part of the MHP laws, so they are intertwined. Although, I think there is some kind of small business exemption for parts of it, so more loopholes.

Honestly, I would rather look to the government to help our profession than to private insurers. Lesser of two evils.

My point is that we need to help ourselves and to look to either entity is problematic as they place their own interests first.

 

[WisNeuro]

Yes they do, but they are entities that we need to work with. We are not the only actors in this play.