Imagine this: you are in your late 20s and have just been diagnosed with bipolar disorder. Your doctor has recommended that you meet with a therapist on a weekly basis and that you see a psychiatrist to monitor your medications. You spend the next two weeks calling every mental health provider in your health plan’s directory before you find a single psychiatrist who will see you—in two months.
In the meantime you sit down with a calculator to add up the price of your medications and weekly doctor visits. The costs are scary. How are you going to balance this new diagnosis, the treatment, the bills and that new job you just started?
For many Americans living with a mental health condition, this is reality. Despite recent laws that improve access to care, many still struggle to find appropriate treatment they can afford.
For many years, insurance companies provided limited coverage for mental health services and some excluded mental health benefits entirely. Those plans that did provide benefits often set limits on the number of visits a person could make to a mental health professional, refused to cover certain types of treatment or limited the amount of money that the health plan would spend on mental health services. Many people seeking mental health treatment found that they were paying for services entirely out of their own pocket and very few could afford it.
Seeking a solution to these problems, Congress passed the Paul Wellstone and Pete Domenici Mental Health Parity and Equity Addictions Act in 2008. Originally, this law applied only to health insurance plans offered by “large employers,” employers with 50 or more people on their staff. While the law did not require insurance plans to offer mental health coverage, if mental health treatment was covered, benefits must be on par with other medical or surgical benefits.
In 2010, Congress enacted the Patient Protection and Affordable Care Act (ACA). The ACA allowed millions of uninsured Americans access to health coverage and health care. The ACA also established mental health and substance use as one of 10 categories of essential health benefits required in most new individual and small group plans sold both inside and outside the ACA marketplaces.
The ACA also extended the Mental Health Parity and Equity Addictions Act to small group and individual plans. While these laws have been a huge step forward to ensure mental health parity and end insurance discrimination, we are a long way from ensuring that all Americans have access to the mental health care they need.
Today, NAMI released A Long Road Ahead: Achieving True Parity in Mental Health and Substance Use Care, a report highlighting the results of a survey given to over 2,700 people about their experience with health insurance coverage. In addition, the report includes an analysis of benefits in ACA insurance plans. In particular, the report found:
- People had serious problems finding mental health providers or psychiatrists in their insurance plan network.
- Many had a hard time getting the type of prescription medication they needed.
- Out of pocket costs were high for both prescription medications and mental health treatment. These costs were a roadblock to care for many people.
- Health insurance companies often denied claims for mental health care.
- When shopping for health insurance, consumers did not have the information they needed to choose the most effective plan.
So, where do we go from here? How can we make sure that individuals have the information necessary to make decisions about health insurance? What can be done to help people gain access to the supports and services they need?
Here is what NAMI recommends:
- Insurers should be required to post up-to-date, accurate directories showing which treatment providers are accepting new patients.
- Insurers should be required to publish the standards they use to approve or deny mental health claims. This information should be clear and easy to access.
- The U.S. Department of Health and Human Services (HHS) should require all health plans to provide clear, understandable, easy to access information about health benefits and should help people make decisions about the health plan that best meets their needs.
- Congress and the federal government must work together to reduce out-of-pocket costs for people with lower incomes.
- Mental health parity laws must be strictly enforced.
These recommendations are just a starting point. There is much work to be done to make sure that everyone with a mental health condition has access to the services and supports they need, but we will not stop until a wide range of effective treatments, services, and supports is available to all who need them.