copayments tagged posts

Will Your New Insurance Plan Do a Better Job Covering Your Mental Health Care?

Gretchen is optimistic that hers will.

The federal government is in shutdown mode but the health insurance marketplaces are open for business. People with mood disorders and their families have the opportunity to explore the pros and cons of different insurance plans that become effective in January 2014. Mental health care must be covered, but will the different levels of plans pay for the services you need? What will you need to pay for yourself?

Gretchen, who lives with a mental health condition, is hopeful that her new insurance will cover her preferred therapist and psychiatrist...

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Participate in Largest Expansion of Mental Health Coverage in a Generation

healthinsurance2The government may not be open for business, but the market exchanges and 24 hour phone lines are operating today!

Marking today’s opening of the health exchanges, Care for Your Mind shares information and resources about who has to have insurance, what’s involved in enrollment, and what we know about mental health care coverage.

Millions more will now have access to mental health care

If you’re looking for health insurance, you have some new options! Today the health exchanges are open for business. That’s because today is the first day of the enrollment period for the health exchanges established under the Affordable Care Act (ACA) to enable the purchase of health insurance.

Here we are providing links to information covering the individual mandate, enrollment in a health exchange, and what is currently known about mental health coverage. Do you know how the ACA is changing health care?

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Are You Getting All the Mental Health Coverage You Deserve?

CarolMcDaidCarol 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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What Can You Do If Your Mental Health Benefits Are Denied?

Carol McDaid
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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Good Business Cents: Mental Health in the Workplace

Clare Miller

Clare Miller
Director, Partnership for Workplace Mental Health

Organizations like the Partnership for Workplace Mental Health and Families for Depression Awareness have long advocated for employers to address mental health in the workplace, citing both visible (e.g., disability payments) and hidden (e.g., lost productivity) costs of depression among employees. As we have previously discussed on this blog, the Affordable Care Act (ACA) requires that mental health care be included in health care coverage. As the ACA carries an affirmative obligation for certain employers  (50 or more employees) to provide health insurance, employers now have the opportunity to impact employees’ mental health broadly through proactive wellness programs and individually through their employee assistance plans and ultimately their health insurance programs.

In this post, Clare Miller explains the essential role of employers in advancing mental health and—even apart from the ACA—the critical reasons for employers to address the mental health needs of their employees.

Employers are an important constituency to engage in advancing mental health in the United States given their power in affecting how much and what kind of care employees and dependents actually receive. Indeed, about 157 million Americans receive coverage through employer-sponsored health insurance.

Employers are getting more involved in healthcare because many realize that employees are their most important asset—their human capital. They’re also focused on healthcare because it is such an enormous expense, as evidenced by the oft-quoted fact that General Motors spends more on healthcare than on steel.

Many employers realize that they can use their purchasing dollars to leverage the healthcare system to demand better quality. And demanding it they are; employers are pushing strategies such as value-based purchasing and outcomes-based contracting. They are aligning incentives to produce better outcomes, as in the case of value-based benefit designs, where copayments might be lowered or eliminated to encourage people to access care and services to manage chronic illnesses.

One of the first examples of this approach was focused on diabetes management. A large employer eliminated the copayments associated with diabetes medication after realizing that high cost-sharing was leading workers to forgo medication, which led to increased hospitalization costs. In response, the employer aligned incentives to be sure that workers could afford the treatment to appropriately manage their condition. Importantly, they married this strategy with others, such as patient education about diabetes management.

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Three Challenges to Accessing Care

Ron Mandersheid, Ph.D.
Executive Director, NACBHDD

Ron Manderscheid

On the May 1 “Access to Care” post, we asked, “If you or a family member needed care today for a mental health or substance use condition, would you be able to get it?”

Access to care can help prevent, delay, and treat mood disorders, other mental conditions, and co-occurring illnesses among the 45.6 million adults and 15.6 million children and youths who experience a mental health condition.

However, in reality:

  • Fewer than 40% of adults and youths with mental health conditions—including mood disorders—ever get any mental health services
  • Fewer than 7% of adults with co-occurring mental and substance use disorders get treatment for both.

Let’s explore access challenges to the prevention, diagnosis, and treatment of behavioral health conditions.

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