叠测听, many U.S. insurance providers that offer mental health care are required to cover it just as they would cancer or diabetes treatment. But advocates say achieving this聽聽can be a challenge. A聽聽released last week by the National Alliance on Mental Illness found that 鈥渉ealth insurance plans are 聽in coverage of mental health and substance abuse conditions.鈥�
Jenny Gold of Kaiser Health News over the weekend about the issue. She noted that many patients have trouble getting their mental health care covered, and she outlined some of the issues confronting both patients and the insurance industry. Here is an edited transcript of her comments.
Where does parity stand?
It鈥檚 been a mixed bag so far. Insurance companies often used to have a separate deductible or a higher copay for mental health and substance abuse visits. 聽Right now, that usually isn鈥檛 the case. In that way, insurers really have complied.
But in more subtle ways , advocates are saying they鈥檙e really not complying. For example, insurance companies, in order to keep down costs, will do things called 鈥渕edical necessity鈥� reviews. Basically, they look at someone鈥檚 care and ask is it really medically necessary. Advocates say they鈥檙e applying those sorts of cost-control techniques more stringently on the mental health side and the substance abuse side than they are on the physical health side. So people are still having trouble getting their care covered.
For insurers, isn鈥檛 it legitimate to say that it鈥檚 more difficult to say something is medically necessary when we鈥檙e talking about mental health?
Insurance companies are arguing this is a really hard law to implement. Clare Krusing, a spokeswoman for 聽the insurance industry鈥檚 main trade group, says the plans are doing their best to make this work.
鈥淭he 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,鈥� Krusing said. 鈥淎nd again this goes back to the fact that we are at a point where health care costs continue to go up.鈥�
She also said that it鈥檚 hard to compare mental and physical health care, that those are two really different things, sort of apples and oranges. It鈥檚 hard to make them exactly equal when treatment often doesn鈥檛 line up, she said, and success can be harder to measure on the mental health side.
How are things going for patients?
Advocates, patients and lawyers say it鈥檚 not going well for patients and that we鈥檝e got something that looks like mental health parity in name only. A 聽poll found that consumers said they were twice as likely to get their mental health care denied than their medical care, which suggests that insurance companies still aren鈥檛 equating the two.
Carol McDaid, an advocate who runs the聽, noted that her group has a helpline to take complaints from people who are having trouble getting their care covered. 鈥淭hey end up with this perception that they have access to care, but when they鈥檙e in a crisis for themselves or their loved one, lo and behold, the care鈥檚 not available because of these cost-control techniques,鈥� McDaid said.
Do patients know what their rights are?
It鈥檚 hard for people to bring a complaint. To prove there鈥檚 been a violation, you have to look at how an insurance company makes decisions on the mental health side and then compare that聽to how they make determinations for medical and surgical treatments. And insurance companies often won鈥檛 give up those documents to be analyzed.
In addition, for a consumer to make a complaint, it means coming聽forward and acknowledging that they have a mental illness. There鈥檚 still a lot of stigma about these conditions. Sometimes it鈥檚 hard for people to step forward, especially when it means telling their employers.
How are states and groups reacting?
There are a handful of states that are taking some enforcement actions, including New York, which has reached聽with some insurance companies, and California. Also, there are many聽individual and class action lawsuits against insurance companies alleging that they are violating mental health and substance abuse parity law. And so that may end up being the way it starts getting enforced.