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For years insurance companies have dictated how much psychological and psychiatric care patients covered by their policies can receive. Most policy plans limited the number of sessions covered per year, with the exception of conditions like extreme anxiety.
Imagine being treated for cancer and being told by the insurance company that you’ll be covered for 2 rounds of chemo, even though your doctor thinks 4 are medically necessarily. Or being told by your doctor that you need to take 10 days of antibiotics to clear an infection from your system, but the insurance company will only pay for 7.
People seeking help for eating disorders have frequently found themselves at odds with their insurance companies, despite having “the highest mortality rate of any mental illness.” Because treatment can last months, if not years, and include very expensive inpatient treatment, insurance companies work hard to limit treatment for those diagnosed, except when patients are speeding towards the point of no return.
Let’s say that you have coverage and that it pays at the beginning of treatment at an eating disorder treatment center. You then learn, though, that it will only pay for the first ten days of your stay. Your treatment plan says that you should stay for six weeks. Given that a treatment center’s cost per month can range in to the tens of thousands of dollars, it’s clear why many families must take out second home mortgages to pay for their loved ones’ treatment.
A treatment plan may include outpatient therapy, residential care, inpatient treatment, hospital care, support from a dietitian, medications or other options. Insurance providers can draw the line in seemingly random and confusing places to disallow parts of the treatment you seek.
In other instances, people find themselves blocked from insurance coverage because of previous use of medications for anxiety or depression. After applying for individual insurance after graduate school, I was turned down for a policy because I had taken anxiety medication in the previous year, while being treated for a series of panic attacks. Since mental health conditions are rarely easy fixes with a short stint on medication, any pre-existing treatment for a mental health issue can make it that much harder to insure.
Why are ailments of the mind judged differently then lifelong allegies in the minds of insurers? What of diabetics that take insulin daily? Surely no one illness is more deserving of coverage than another. And why should your co-pays differ if you see a psychiatrist, instead of a urologist?
While it shouldn’t take an act of Congress to achieve mental health parity in insurance coverage, Americans recently got one to usher in a bit more fairness in their health care coverage.
Remember that 2.5 page Wall Street bailout/rescue that turned into a 417 page bill, filled with the special projects needed to get the support of enough Congresspersons and Senators to pass? The Wall Street Bailout mandated change via the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 .
Under the bill, if a group health plan covers the treatment of mental illness or drug or alcohol abuse, the treatment limits and financial requirements for these services can be ‘no more restrictive’ than those that apply to medical and surgical benefits.
What this means, the bill says, is that co-payments, deductibles and out-of-pocket expenses for mental health services cannot be higher than those for treatment of physical illnesses.
By January of 2010, insurers will be treating physical and psychological conditions equitably. And it can’t come soon enough for the 8 million suffering from an eating disorder, 15 million depressed Americans or overwhelmed college students. A 2004 study found that,”Almost 40% of the men and 50% of the women reported feeling so depressed that they had difficulty functioning one or more times.”
It’s especially important to women since 7 in 8 diagnosed with an eating disorder are women, and women are twice as likely to become depressed compared with men.
Unfortunately, for women, this bill doesn’t begin to address the higher premiums women pay for the same insurance coverage available to men. But we’ll save that conversation for another blog post.
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