Insurers’ failure to comply with MHPA impacts mental problem treatment, says report

Insurers’ failure to comply with MHPA impacts mental problem treatment, says report

America’s one of the leading health care consulting and risk management company Milliman Inc. recently released a report that analyzed the gaps in medical insurance benefits for mental health and addiction care. The report was presented by a coalition of mental health and addiction advocacy organizations like the Mental Health America (MHA), the National Alliance on Mental Illness (NAMI), and The Kennedy Forum. The report was prepared after collecting data from two exhaustive national databases comprising medical claim records from leading insurers for preferred provider organizations (PPO). The databases contained data of nearly 42 million Americans across 50 states and the District of Columbia between 2013-15.

The report stated that despite the presence of the Mental Health Parity Act (MHPA), passed by Congress since a decade, people struggling with a mental health disorder or an addiction still struggle to receive adequate care, despite the promises to bridge the gaps between care services, providers and patients. The major findings of the report were:

  • In comparison to medical and surgical care, behavioral health, including mental health and addiction, care was likely to be provided by out-of-network services, by four to six times. This implied that the patients were likely to spend humongous amount of money from their own pockets. This is one of the chief reasons for non-compliance to the treatment even by those who have insurance plans.
  • Ironically, the insurance payers reimbursed the primary care physicians by four to six times more than they pay the mental health specialists for the same level of care. This was one of the reasons for shortage of providers as they did not agree to associate with insurance companies because of the disparity in reimbursements.
  • The statistics were widely different for different states. In California, 32 percent of office visits for behavioral health were out-of-network while the same was 63 percent for Washington.

Insurers have an upper hand due to gray areas

The Mental Parity Act was passed with the aim of eliminating the differences and some of them have been attended to, such as  insurers have dropped limits on the number of doctor visits, and higher co-payments and discrete mental health deductibles are not much of an issue now. Still, plenty of gray areas exist where insurers have an upper hand and the monopoly to manipulate the laws. For example, insurers get to decide whether a patient requires a behavioral health treatment and for what duration. Because of lack of strict enforcement by the government, most patients do not know whom to turn to for complaints.

The Department of Labor, that monitors health insurances offered by large employers, had set up a complaint helpline but the same is not known to plenty of patients and even if they do, they don’t know how to go about it. Since insurance companies were in the coalition that facilitated the launch of Affordable Care Act (ACA), the administration feels indebted to them and finds it challenging to approach them for any misconduct.

Road ahead

When an insurer violates the parity act, it is important that it discloses all the documents pertaining to an issue so that the law officials could establish an anomaly on the insurer’s part, but insurers rarely comply with it and do not share the details. The troubled patients and the families feel that strong intervention by the government is indispensable to ensure full compliance of the mental health parity act. In the absence of it, the patients are mostly on their own, often abandoning the treatment in between and suffering from relapse.

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