He was a typical 17-year-old. He was on his high school debate team and played several sports. And like many of his peers, he hid his depression.
Once the family discovered it, they faced hurdle after hurdle from their health insurance company over getting treatment for him. While the battle continued, he took his own life.
Beginning January 1, 2010, the Mental Health Parity and Addiction Equity Act of 2008 will align mental health/substance abuse and medical-surgical benefits for group health plans that cover more than 50 employees. The aim is to treat mental and physical health equally.
According to the American Psychiatric Association, while the Federal government has yet to issue regulations to clarify what the law intends, it still takes effect on January 1. Congress has been notified that the government still plans to issue these regulations by the implementation date.
If you or family members participate in a covered plan – it must already include coverage for mental health and/or substance use disorders – the Act will affect your coverage. It requires that your plan provide coverage with no greater financial requirements than the predominant requirements that it applies to substantially all medical/surgical benefits. This applies to co-pays, deductibles and annual or lifetime dollar limits. Insurance companies are waiting for an interpretation of exactly what the terms predominant and substantially mean. Meanwhile, they’re making changes based on their best guesses.
If your current insurance limits the number of mental health or substance abuse treatments visits you can make to a provider, that restriction should be lifted. If your plan contains lifetime limits, the ceilings should be the same for both medical-surgical and mental health-substance abuse claims. For example, if the lifetime limit for treatment relating to a patient’s diabetes if $1 million, the cap for visits to a mental health practitioner can’t be $100,000. Assuming a medical necessity, you should insist on access to treatment for yourself or covered family members.
According to the U.S. Department of Health and Human Services, the Centers for Medicare and Medicaid have jurisdiction over self-funded public section (non-Federal government) plans. The U.S. Department of Labor maintains jurisdiction over private section self-funded group health plans.
If you feel your plan is covered by but not in compliance with the Mental Health Parity Act as of January 1, 2010, first contact your human resources department. The second step is getting in touch with your state health insurance department.
American Psychiatric Association site
U.S. Department of Health and Human Services site