insurance tagged posts

Now That You Understand Mental Health Parity Issues, How Will You Respond?

TAKE ACTION

Since the first of the year, CFYM has informed and educated our readers  about the issues of mental health parity. Our guest bloggers have asked, “If we don’t have access, do we really have parity?” Others have revealed the tragic results that can occur when access is lacking. Still others have pointed out the disparity between states.

The one point they all have in common is a plea for you, the reader, to take action! Taking action means getting involved. Below are some suggestions:

  • Understand your insurance benefits
  • Challenge stigma
  • Contact your elected officials

While the words are simple on paper, actually taking steps is anything but. That is why CFYM, in partnership with the Depression and Bipolar Support Alliance (DBSA), wants to make getting involved easier for our readers.

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What Should Employers Do to Increase Access to Mental Health Care?

Ken Dolan-Del Vecchio

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 Often network information is outdated or incorrect, and it can be extremely time-consuming and frustrating to obtain an appointment.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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How Can We Achieve Mental Health Parity If There Are Not Enough Practicing Psychiatrists?

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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If Access is Lacking, Do We Have Mental Health Parity?

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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Medicare Part D Users are Feeling the Squeeze

If concerns about being able to retain access to the correct medications to treat their mood disorders was not enough, individuals utilizing Medicare Part D must also be concerned about whether or not they can even afford to take their prescribed medications.

When Medicare Part D took effect in 2006, it arrived with mixed reviews. Today, according to a survey conducted by Medicare Today, 86% of seniors say they are satisfied with their prescription drug plan. One reason they site for the satisfaction is that the costs are reasonable. Given the way things are trending however, the Center for Medicaid and Medicare Services (CMS) may see satisfaction dip.

Cost related non-adherence to medication protocols is growing. The inability to pay for costly medicines causes patients to stretch out their prescriptions by skipping or taking smaller doses than prescribed. In in a recent Health Affairs study, (Medication Affordability Gains Following Medicare Part D Are Eroding Among Elderly with Multiple Chronic Conditions) seniors experiencing four or more chronic conditions reported a cost-related non-adherence rise from a low of 14.4% in 2009 to 17% in 2011.

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Speak Out About Potential Reductions to Medicare Part D Benefits

Last Tuesday, September 30, DBSA participant Trudy Lapin shared her story during two Congressional briefings sponsored by the Partnership for Part D Access. Trudy used her time to explain to Congressional staff from both the House and the Senate why a proposed regulation by CMS to restrict access to medication that aids in the treatment of mood disorders is misguided. You can read Trudy’s statement below, and learn how you can share your story with your own elected officials.

Treatment is not one size fits all
Although I was first diagnosed officially with major depression in 1993, signs of that particular mood disorder appeared in childhood. While attending college, an over achieving pattern went into high gear. I elected a double major in French and English literature with a minor in secondary education. I graduated with highest honors; accepted a full fellowship to Yale Graduate School to pursue my doctorate in Romance Languages and Literatures; taught French language, literature, and film at Yale College and at the University of Chicago; and was awarded a National Endowment for the Humanities grant, where I enjoyed the privilege of working with humanities scholars at Princeton University.

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How Will You Protect Access to Quality Mental Health Care for Seniors?

Today the Partnership for Medicare Part D will hold a Congressional briefing to discuss the significance of Medicare’s “Six Protected Classes” policy giving seniors access to quality mental health care. While you may not be able to attend in person, it is still critical that you educate your Congressional Representative and Senators on the importance of retaining these benefits.

How Will You Protect Access to Quality Mental Health Care for Seniors?
According to the Geriatric Mental Health Foundation depression impacts more than 6 million of the 40 million Americans over 65. Health problems become more common and increasingly complex as seniors age. With the onset of more serious conditions such as heart disease, stroke, cancer, arthritis, Alzheimer’s disease, and Parkinson’s disease, individualized medicine becomes increasingly critical to helping seniors manage their mental and physical health.

This is why Congress carved out six protected classes of medications when they authorized Medicare Part D. Their intent was that seniors would have access to these medications without regulatory burdens. The preservation of the six protected classes is critical to providing treatment for serious, complex health conditions without delay or restricted access to essential treatment.

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Louisiana is a National Leader with their “Prescriber Prevails” Medicaid Policy

BenNeversBen Nevers
State Senator Louisiana

For the past three weeks we’ve devoted this blog to raising awareness around a proposed regulation by the CMS to restrict access to mental health care. But did you know that individual states have fail first policies as well, through the implementation of their Medicaid programs? Read today’s post to learn if your state is on the list.

Louisiana is a National Leader with their “Prescriber Prevails” Medicaid Policy
Keeps access to medication in the hands of physicians and patients

There are many reasons why people do not receive adequate mental health treatment, each of those reasons is as unique and as highly personalized as the individuals themselves. Yet, nearly all stem from the fundamental problem of access. Access to timely, appropriate, affordable mental health care is too often limited and restricted as a result of the following:

  • a shortage of providers or inpatient beds in a given community
  • insurer restrictions on what, when and how providers can prescribe medication and treatment
  • cost barriers that put mental health care financially out of reach

When such barriers obstruct access to care, more people are at risk for serious, disabling mental illness; and in those cases, society bears the related costs. For that reason, I believe we must work together to address these barriers and expand access to mental health services. The cost of not doing so is enormous.

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