Paul Gionfriddo
President Mental Health America

That’s the bottom line message in a recent report, entitled Parity or Disparity: The State of Mental Health in America 2015, released by Mental Health America (MHA).

But the good news is that there are plenty of things we can do to change that – if we’re willing to change the way we approach mental illnesses in general.

MHA produced this report because we aren’t satisfied with the narrowness of the policy debate we have been having. It has been too much about public safety and post-crisis intervention, leading to a focus on inappropriate, back end, post-crisis care. These interventions occur long after mental health concerns—if identified and treated early—could be eliminated or mitigated, avoiding crises and tragedies.

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Ken Dolan-Del Vecchio, LMFT, LCSW, DVS, CEAP, SPHR
Vice President, Health and Wellness, Prudential Financial, Inc.

I read Carolyn Beauchamp’s recent post CFYM with interest, but not surprise. Ms. Beacuchamp discusses the inadequacies of insurers’ behavioral health networks and highlights the challenges that insured patients encounter when seeking mental health care. Often network information is outdated or incorrect, and it can be extremely time-consuming and frustrating to obtain an appointment. For someone in a worsening mental health state, such obstacles are frustrating at best, catastrophic at worst.

While Carolyn’s piece sheds light on this important issue, it is—unfortunately—not news to those of us who work in the behavioral health field. As a practitioner, I experienced the frustrations of patients struggling to find an in-network provider or schedule an appointment within a reasonable time frame. Now, in my current role as Vice President, Health and Wellness, at Prudential Financial, I work to combat these challenges and reduce obstacles to care.

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A provider’s perspective on the limited access to mental health care

Dr. Philip R. Muskin
Professor of Psychiatry
Columbia University Medical Center

As a practicing psychiatrist and patient advocate, I strongly believe that equal treatment and quality care should apply to someone who has a chronic mental health illness, like schizophrenia or major depressive disorder, requiring ongoing therapeutic and complex medical management, just as would apply to a patient in need of cardiovascular treatment or other chronic medical issue.

I’m troubled and frustrated by the rash of recent studies finding that patients across the United States are unable to obtain a timely appointment with a local mental health provider, notably a psychiatrist, who accepts their insurance coverage. This growing problem, old news to those of us practicing in the field, is multi-faceted and a fix will require a significant commitment to change on the part of many involved in the delivery and financing of health care. Unfortunately, it’s not clear such a commitment yet exists.

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Carolyn Beauchamp
President and CEO, Mental Health Association in New Jersey
Mental Health Association of NJ Finds Access to Providers Lacking 

Rhonda’s story 
Rhonda, a young woman living with both bipolar disorder and an eating disorder for most of her life, was frustrated. She’d been trying for weeks to find a new psychiatrist, after being released from an inpatient clinic, where she was treated for a severe bipolar episode. On a list of 15 providers, several were simply unreachable, either wrong numbers or no answer. When she got through to the others, they were either not accepting her insurance or had a 4-6 week wait for an appointment. She felt distraught and hopeless. She didn’t know how she would cope.

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Cause for celebration or just one victory in a long-term battle

On November 8, 2013 the Obama administration released the final rule providing guidance on how health insurance plans should implement mental health parity. In short, the rule states that mental health coverage must be equitable to how insurance plans cover other physical conditions. Restrictions accessing care and reimbursement for services can no longer be different for mental health in relation to other health care services. Additionally the ACA, more popularly known as Obamacare, requires that mental health coverage be included as an essential health benefit for plans available through the market exchange.  In short, as of January 1, 2014 private, marketplace exchange and Medicaid Expansion plans must offer mental health care and it must be with parity.

Much has been written about the ruling. Most of it positive. Bloomberg BNA states advocates are praising the rule. The National Council applauds the ruling saying it is “a huge victory for people living with mental health needs and for the nation as a whole.

CFYM has covered the topic in past blogs and has provided instructions on how to fight for your coverage rights by challenging an insurance claim denial. Carol McDaid of the Parity Implementation Coalition posted on September 19 that now is the time to become an informed, empowered, and vocal consumer. There is much work still to be done to ensure the civil rights and protection of people living with a mental health condition when it comes to access, however.

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Carol McDaid
Winning strategies for filing a mental health insurance coverage grievance

CFYM Note: This is the last in the series by Carol McDaid on your rights with regards to mental health insurance parity laws and expanded coverage under the Affordable Care Act. Tuesday’s post provided an overview of what types of denials to look out for. Today, Ms. McDaid tells readers how to file a grievance for denial of mental health insurance coverage.

When should I file an appeal

Mental Health America compiled this list of questions to help you understand if you should appeal a coverage denial. At first glance, the questions may seem to require a sophisticated understanding of your plan and the law, but you can simplify it this way: If the answer is YES to any of the following questions, the plan is most likely not in compliance with the new laws.

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Carol McDaid
Parity Implementation Coalition

Follow these practical steps to win your appeal.

CFYM Note: Last week, Carol McDaid answered the question, “Doesn’t health insurance have to cover mental health care?” She also described steps to make sure you’re getting all the health care benefits you should. This week, Ms. McDaid covers what the mental health parity law means for you when you don’t get the benefits you’re entitled to.

From promise to reality

The fact that we now have two federal laws requiring mental health parity is cause for celebration—both for those of us who spent years advocating for the laws and those of us, me included, who have been denied coverage by our insurance plans.

The Mental Health Parity and Addiction Equity Act was signed into law in 2008. The Affordable Care Act goes into effect January 1, 2014, and will require more plans, including those in the newly created health insurance exchanges, to offer mental health parity. (Read more about the laws in Part 1 of this series.)

The federal laws are on top of state laws that exist in approximately 40 states to protect people from being denied mental health benefits through public and/or private employer-sponsored health insurance. (View a chart of state mental health parity laws from the National Alliance on Mental Illness.)

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Carol McDaid
Parity Implementation Coalition

CFYM Note: This is the second in a series of posts by Carol McDaid about mental health insurance parity and coverage rights under the Affordable Care Act (ACA). In the first post on Tuesday, Ms. McDaid advised us to learn about the law and be alert for upcoming changes. Remember, the health exchanges open for business on October 1.

Study your mental health care benefits and know your options

Whether you are purchasing insurance for the first time through one of the new health exchanges, interested in changing coverage during open enrollment, or simply frustrated with your mental health coverage, now is the time to become an informed, empowered, and vocal consumer. You need not wait for the MHPAEA final rule or the ACA’s effective date to understand how mental health parity laws can best serve your health needs. If you are engaged now, you are more likely to be prepared for any inequities or discrepancies you might encounter.

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