The Good News: You Now Have Health Insurance. But Will You Be Able to Access a Psychiatrist?

Depression and Bipolar Support Alliance

“Worsening of symptoms,” “inability to work,” “hope for the best,” “stretch my medication” are a few of the reported consequences people face when they are unable to obtain an appointment with a psychiatrist. These responses and others like it come from a survey conducted by the Depression and Bipolar Support Alliance (DBSA) that revealed the challenges people face when their health insurance plans lack an adequate number of in-network psychiatrists. The short survey revealed that 38% of respondents were not able to make an appointment with an in-network psychiatrist and 40% believed the wait time between seeking an appointment with a psychiatrist and being seen was too long.

A mental health parity issue
DBSA and other mental health organizations have taken on this concern as a mental health parity issue. One of their goals is to advocate for solutions by identifying and defining the problem. Building on what was learned from the previous survey, DBSA is seeking more insight into the lengths individuals and families go to obtain care. To that end, we invite everyone to take our Access to Psychiatrist survey.

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New Jersey Parity Coalition Uses Multi-Pronged Strategy to Fight Insurance Plan Inequities

Picture of Aaron Kucharski

Aaron Kucharski, New Jersey Parity Coalition

 What happens when there are laws on the books granting you equity, but when you try to use them as intended, you meet nothing but obstacles? That’s what many family members in New Jersey were asking when they tried to take advantage of the new mental health parity laws that increase access to care. Among those individuals was Valerie Furlong, who was seeking care for her two teenage sons. When she connected with other family members facing similar challenges, Valerie quickly learned that she was not alone in her frustration. She and others like her decided to take action against these obstructions and join forces with the New Jersey Parity Coalition.

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We Have Mental Health Parity Laws! Is Our Work Done? Implementing and Enforcing Mental Health Parity at the State Level

Picture of Kelly O’Brien

Kelly O’Brien, The Kennedy Forum Illinois

When the historic Mental Health Parity and Addiction Equity Act of 2008 (“Federal Parity Law”) was enacted, Americans expected to have fewer barriers to access mental health and addiction services, and expected that behavioral health benefits would be provided on par with other medical/surgical health plan benefits. As Tim Clements of ParityTrack shared in a previous CFYM post, it is largely the state regulatory agencies that are responsible for implementing and enforcing the Federal Parity Law. Unfortunately, it’s now eight years since MHPAEA became law, and most states have not fulfilled that obligation, including Illinois. The result is that health plan beneficiaries continue to be denied access to behavioral health services and remain unaware of their right to access care as a part of their health plan’s covered benefits.

Authored by former Congressman Patrick J. Kennedy, founder of The Kennedy Forum, the law requires health insurance plans to guarantee that financial requirements and limitations on treatment benefits for mental health or substance use disorders are no more restrictive than the insurer’s requirements and restrictions for medical and surgical needs. The Affordable Care Act (sometimes known as Obamacare) expanded the Federal Parity Law to apply to even more health insurance plans.

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Equal Health Insurance Benefits Is the Law, But Are the States Enforcing It?

Tim Clement Photo

Tim Clement, Policy Director, ParityTrack

For most of the history of modern American health care, mental health treatment was not covered by insurance the same way other medical treatment was covered. Insurance plans often implemented arbitrary and restrictive annual and lifetime limits on inpatient days and outpatient visits. Copayments and coinsurance rates were often far higher than they were for other medical care. Separate and more expensive deductibles for mental health care were the norm.

Thankfully, the Mental Health Parity and Addiction Equity Act of 2008 (the Federal Parity Law) made this form of separate and unequal insurance coverage illegal. The Federal Parity Law prohibits insurance plans from imposing treatment limitations and financial requirements that are more restrictive for mental health and substance use disorder treatment than those used for the treatment of other medical conditions.

The good news is that health insurance coverage that discriminates against people with behavioral health conditions is now against the law. The bad news is that nearly a decade after President George W. Bush signed this landmark piece of legislation into law, insurance coverage for treatment of mental illness and addiction still is not on par with insurance coverage of other medical conditions.

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Shared Decision Making – with Families – Yields Better Treatment Outcomes

Alison M. Heru, M.D.
Professor of Psychiatry, University of Colorado Denver

In the NES Program at University of Colorado Health, a six-month program combining neurology and psychiatry treatment for non-epileptic or non-electrical seizures, psychiatrist Dr. Alison Heru makes shared decision making an integral part of practice.

In my experience, shared decision making yields the best results in treatment. When patients feel like they have participated in choosing the treatment and are able to ask questions and weigh alternatives, they are more likely to feel they have selected the treatment that is the best for them and have a stronger stake in the outcome.

At the NES program (addressing non-electrical seizures), there’s not clear evidence for which treatment approach will be best for each patient. It’s my role, then, to make sure we make the correct diagnosis, provide information about the treatment modalities available, and decide together with the patient (and the patient’s family, unless not available) on the treatment plan. I won’t tell the patient what to do or to force a choice on them, but I will offer my opinion.

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How Can Parents Help in Shared Decision Making?

Families for Depression Awareness for Care for Your Mind

Your teenager has been diagnosed with a mood disorder and the clinician is talking with her or him about treatment. What is your role as a parent in the shared decision making model? How can you participate?

At Families for Depression Awareness, we believe that parents can play an essential role in recognizing and addressing mood disorders in their children. When you’re worried about a teen in your life, you might need to take crucial actions in a crisis situation, convince a reluctant teen to go to a mental health provider, or be supportive in finding and accessing mental health care.

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How Peer Specialists Enhance Shared Decision Making

Tom Lane, Certified Recovery Support Specialist

Much has been written about patient-centered care. Proof that this model is gaining acceptance is the evolution to shared decision making (SDM). The National Learning Consortium defines SDM as a “process in which clinicians and patients work together to make decisions and select tests, treatments and care plans based on clinical evidence that balances risks and expected outcomes with patient preferences and values.”

In a recent CFYM post John Williams, M.D., writes that there are several tools that clinicians can use to step through the shared decision making process. Dr. Williams opines that when there are many different treatment options, SDM takes on added importance. As a result, a major step in the SDM process must be for clinicians to understand the desired outcomes of their patients.

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Use Shared Decision Making to Maximize Health Insurance Benefits

Depression and Bipolar Support Alliance for Care for Your Mind

It’s no secret that out-of-pocket healthcare costs—the amount you pay—have risen significantly. These expenses have been trending upward for over a decade and there is no indication that this trend will end anytime soon. In 2013, according to the HealthAffairs Blog, nearly one-third of participants in an employer-sponsored plan had a high deductible. Plans purchased through the federal marketplace have similar out-of-pocket costs, especially at the Bronze level.

The rationale behind Health Savings Accounts (tax-free accounts where money is set aside for medical expenses) is that, when people have a financial investment in their healthcare, they are more likely to make better decisions about how they consume or use this commodity. It’s fair to say that this idea can also support the trend towards higher copays or co-insurance.

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