by Jeff Broddle
NOTE: A recent telephone survey of adults in Northern Lakes CMH’s service area indicates overwhelming support for insurance parity. 93% of those surveyed strongly or somewhat agree that health insurance plans should be required to provide equal coverage for people with mental illness and for those with physical illness.
Imagine your doctor saying you can be treated for the flu but not for a broken leg. Most reasonable people would agree that if an individual has health insurance, what kind of illness he has shouldn’t make a difference to whether or not he receives treatment.
Some mental health professionals, however, point to how mental illness is covered on insurance compared to how physical illness is covered. In other states, laws have been passed requiring health plans to offer mental health benefits on a par with physical health benefits.
For example, under parity legislation, an insurance provider cannot place a lower lifetime limit for mental health treatment than it does for physical health treatment.
Parity legislation was introduced in Michigan last year but did not come up to a vote in either the House or Senate, according to Greg Paffhouse, chief executive officer of Northern Lakes Community Mental Health.
“We remain hopeful that new legislation will be introduced this year,” Paffhouse said.
When a parent takes a new job, he asks questions about how his family will be covered. Is there health insurance? How about dental? What about vision?
But it would be rare for a parent to ask about mental health coverage for his child.
“It’s a stigma; they won’t demand it until they need it,” said Mary McAndrews Hubbard, chief operations officer for children for Northern Lakes Community Mental Health.
One parent who found out she did need it is Chris Davis. Davis has a 16-year-old son who suffers from serious emotional disturbance and developmental disabilities, as well.
Davis agrees her family is fortunate because they have both Blue Cross/Blue Shield insurance coverage and Medicaid coverage for their son. Most of their needs not covered by the Blues are picked up by Medicaid.
But insurance payments for mental illness are not always as forthcoming as those for physical illness, and that disparity concerns both families and mental health professionals.
“As a contractor, I can tell you the insurance carriers limit the mental health benefits and don’t get nearly the availability of mental health care that you get for physical health care,” said Eric Harvey, Ph.D., a contract psychologist with Northern Lakes Community Mental Health.
“People believe that behavior is something people can correct by themselves,” Davis said.
“But just like you can’t lower your own blood pressure, you can’t do this for yourself. You need help,” Davis said.
In some cases, insurance companies recognize the need for long-term care for physical illnesses but hold back on providing equal care for mental illnesses. The issue is known as mental health parity. Other states have passed laws requiring insurance companies to not put limits on mental health access that do not also apply to physical health. For example, parity in health insurance for mental illness does not allow an insurance company that offers treatment for mental illness to place a more restrictive lifetime limit for treatment than it does for physical illness.
Davis knows that while her son can improve with treatment, he’ll probably never be a fully functioning adult.”He will always need extra help,” Davis said. “The fear is that some day that extra help will stop coming. A mental health parity law in Michigan would help ensure that treatments for mental illness are not abruptly cut off.
Part her son’s treatment, Davis said, involves trying different medications to find the best balance.
“When you find the right medicine, you guard it with your life,” Davis said.
One of Davis’ fears is that her insurance company will decide to change her son’s coverage to a different drug that doesn’t work as well.
“And that change could be devastating,” Davis said, explaining that the disruption could take her son back months in his hard-fought progress.
Mental health parity for insurance providers would mean that mental ailments would be treated like any physical condition, according to Jim Skiera, mental health counselor for Catholic Human Services.
Skiera said he sees ¨couples who are having problems, couples who are trying to cope with a separation, an affair, or a divorce.
“Those are all extremely stressing and anxiety-producing, and (they) potentially produce symptoms that fit diagnostic categories that are reimbursable by insurance companies,” Skiera said.
Negative situations can cause people to suffer from anxiety, depression, or personality disorders, but although they might originate from the interaction of a marriage, insurance companies don’t cover marriage counseling.
“They don’t want to say this is what is behind the symptoms,” Skiera said.
Some groups have a difficult time obtaining mental health care, Dr. Benthem said. Patients affected include those who are out of work or who may have never held a job.
A vicious cycle can develop with employees who are out of work for emotional or mental health reasons. Individuals with depression or addiction patterns have a hard time holding down a job, and without a job they are unlikely to be able to afford treatment.
“So it’s kind of a cycle,” Dr. Benthem said.
Even patients who do have insurance coverage face higher bills for psychological conditions than they would for a physical condition.
Take, for example, a patient with clinical depression. Usually the best treatment is a combination of prescribed medication along with cognitive therapy, according to Harvey. Therapy sessions may cost $112 per visit, with Blue Cross paying half. Successful treatment may require ten to 20 sessions, making the patient’s share in the range of $560 to $1,120. Compare that to a co-pay of $10 to treat a physical condition.
“And parity will address that,” Harvey said.
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