Mental Health Coverage Overview
This is one of the most commonly forgotten factors while taking a health insurance. It’s about time that we look into this at least now. Traditionally, insurance coverage for mental health care has been less generous than that for medical and surgical care. Patients seeking coverage under their health insurance for what insurance companies usually refer to as "behavioral health" often are faced with a limited number of doctor visits per year, higher out-of-pocket limits and deductibles that they must pay in addition to their medical deductibles.
The Mental Health Parity and Addiction Equity Act of 2008 continues and expands the rules established by the Mental Health Parity Act of 1996, according to the federal Centers for Medicare and Medicaid Services. The 1996 act required that lifetime annual dollar limits for mental health coverage be on par with those for medical coverage. But it did not address out-of-pocket costs (like co-pays) and left substance abuse treatment coverage out entirely.
Discover Mental Health Coverage
This new legislation (passed in 2008 and implemented in 2010) requires group health plans offering mental health coverage to ensure that financial burdens (co-pays and deductibles) and limitations (number of visits) for mental health and substance abuse are no more restrictive than those for medical and surgical benefits. In other words, if an insurer chooses to offer it, coverage for mental health must be just as comprehensive as that for physical health. The 2008 law expands not just mental health coverage but also the number of people who seek mental health services.
Those who have mental health coverage as part of their health insurance should review their health plans to determine whether these new regulations have been carried out. A limited number of outpatient visits or a limited number of days for an inpatient stay may no longer apply, for example. In some cases, an old health plan may have covered just enough visits for a mental health professional to conduct an initial assessment and build rapport, leaving hardly any opportunity for substantive treatment.
Concepts of Mental Health Coverage
Going forward, those who believe they've been denied coverage or received limited coverage should ask their doctor for a written explanation of why the treatment is medically necessary and file appeal with the insurance company, according to guidelines from the nonprofit Mental Health America. An external appeal may be possible through your state's insurance commissioner.
The economic impact of mental health parity is anything but certain. It's just as easy to find data suggesting that mental health parity will substantially increase health insurance premiums as it is to find evidence suggesting that premiums won't rise at all.
Tips and comments
Mental Health Coverage Final Thoughts
In "The Case against Mental Health Parity," the National Center for Policy Analysis cites PricewaterhouseCoopers in claiming that the mental health parity mandate would increase insurance premiums by 10 percent. In contrast, U.S. Rep. Ed Homan, a physician from Florida, published a summary of findings demonstrating that costs rose by much smaller amounts after mental health parity was carried out.
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