Mental health is just as vital as physical health when it comes to our overall well-being. Regrettably, insurers haven’t always shared this viewpoint. Many health insurance companies used to provide better coverage for physical illnesses than they did for mental illnesses.
The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (also known as the mental health parity law or federal parity law) was passed in 2008 and requires mental health, behavioral health, and substance-use disorder services to be covered in the same way that physical health services are covered. Despite this, many people are unaware of the law or how it impacts them. In fact, according to a 2014 APA poll, more than 90% of Americans are unaware of the mental health parity rule.
What does the law do?
The federal parity law requires insurance companies to treat mental and behavioral health and substance use disorder coverage in the same way that medical and surgical coverage is treated (or better). As a result, insurers must address all financial needs equally. For example, an insurance company cannot charge a $40 payment for office visits to a psychologist if it only charges a $20 copay for most medical/surgical office visits. Non-financial treatment limits are also covered by the parity law. Limits on the amount of mental health visits allowed per year, for example, were historically commonplace. Annual limits have been essentially eliminated by the law. It does not, however, prevent the insurance provider from imposing limits based on “medical necessity.”
What health plans does the law affect?
The federal parity law covers the following types of health insurance in general:
- Coverage obtained through health insurance exchanges established under the Affordable Care Act (commonly known as “Obamacare”), a health-care reform law.
- The majority of Medicaid programs. (Requirements may differ from one program to the next.) If you’re unsure whether the federal parity requirement applies to your Medicaid program, contact your state’s Medicaid director.)
The parity law does not apply to some other government plans and projects. In contrast to Medicaid, Medicare is not subject to the federal parity requirement. Additionally, some state government employee plans (such as those that cover teachers and state university employees, for example) may be exempt from the parity rules.
How do I know if my health insurance plan provides mental health coverage?
Check your plan’s summary of benefits for information on behavioral health services or coverage for mental health and substance abuse disorders. If you’re still unsure, ask a member of your human resources department or call your insurance company directly.
My insurance plan doesn’t have mental health benefits. Is that a violation of the parity law?
The parity law does not oblige insurers to give mental health benefits; rather, it stipulates that if mental health benefits are provided, they must meet the same standards as physical health benefits. Fortunately, before the parity rule took effect, the vast majority of big group policies already covered mental health benefits. Furthermore, the Affordable Care Act mandates that plans sold through health insurance marketplaces cover mental health and substance abuse treatment.
Are all mental health diagnoses covered by the parity law?
The federal parity statute applies to any mental health and substance-use disorder diagnoses covered by a health plan, unlike some state parity rules. A health plan, on the other hand, is able to deliberately exclude certain illnesses, whether they are considered physical/medical or behavioral/mental health diseases. Any exclusions in your plan’s statement of mental health benefits should be made known to you. If you have any doubts, contact your insurance carrier.
My insurance company won’t reimburse me for a therapy visit because I haven’t met my deductible. Is that a violation of the parity law?
A deductible is the amount you must pay out of pocket each year before your health insurance company pays anything. For example, depending on your insurance plan’s deductible, you may have to pay $500 or $5,000 out of pocket before your insurer will pay any claims. Many insurance plans required patients to satisfy separate, and sometimes higher, deductibles for mental health care than for medical services prior to the parity rule. As a result of the reform, both mental health and medical therapies now have a single deductible. In some circumstances, your plan will cover mental health therapy after you’ve met a portion of your deductible, but not physical health treatment until you’ve met the entire deductible.
My copay is $20 when I see my psychologist, but only $10 when I visit my primary care physician. Isn’t that against the law?
Certainly not. Copays for mental health services must be equivalent to or less than the cost for most but not all medical/surgical services, according to the parity statute. It’s fine to pay a $20 copay for a mental health appointment and a $10 copay for a primary care visit in this scenario, as long as your copay for most medical/surgical treatments covered by your plan is $20 or higher.
My insurance company has only approved a certain number of therapy sessions to treat my disorder. Is this a violtion of the parity law?
The parity rule makes it illegal for insurers to set a strict annual limit on the amount of mental health sessions that are covered. Insurance companies, on the other hand, can still control your care. According to your plan, after 10 or 20 visits with a psychologist, they will examine your case to see if more therapy is “medically necessary” based on their criteria. Under the parity law, this type of management is generally permitted if the employer applies the same principles to deciding mental health coverage as they do to determining what medical services to cover. However, if the firm terminates or reduces care considerably sooner than your psychologist believes is necessary, it could be a breach of the parity rule.
My mental health provider won’t accept my insurance, even though I have mental health coverage. Why not?
Psychologists and other mental health professionals have the option of accepting or rejecting insurance. Despite escalating administrative costs of establishing a practice, many insurance companies have not adjusted the reimbursement rate for psychologists in 10 or even 20 years. Other companies’ reimbursement rates have recently been reduced. As a result, several plans are having difficulty recruiting mental health professionals to join their networks. If your alternatives appear restricted and your insurance is supplied by your company, you should talk to your human resources representative about your concerns. He or she may take this into account in the future when negotiating your company’s insurance plan with insurance firms.
My insurance covers out of network providers. What do I need to do to get reimbursed for psychotherapy services?
If your health plan supports mental health services provided by out-of-network providers and you are seeing a mental health provider who does not accept your insurance, fill out an insurance claim form and submit it with the mental health provider’s invoice to get reimbursed. Contact your insurance company if you have any questions about your health plan’s out-of-network provider claim procedures.
Who should I talk to if I think my insurance company is violating the parity law?
If you’re concerned that your plan isn’t compliant with the parity rule, request a summary of benefits from your human resources department or contact your insurance carrier directly. Your HR department can provide you with information on your benefits and may be able to connect you with a health care advocate who can help you file an appeal. If additional employees are experiencing similar problems, your HR department may want to keep track of the concerns and collaborate with the insurance company to ensure that benefits are fulfilling employee demands. If you don’t have access to an HR department or if your insurance isn’t offered by your employer, you could choose to contact the insurance company directly. Check the back of your insurance card for a customer service number to contact your insurance carrier. If you purchased your insurance through an insurance exchange, your state insurance commissioner may be able to assist you.
If you still have concerns or want to submit a parity complaint, go to the Employee Benefits Security Administration (EBSA) Consumer Assistance web page and click on “Ask a Question,” “Submit a Complaint,” or “Report a Problem.” You can also contact 866-444-3272 to reach the EBSA’s toll-free consumer service line. Another useful website is the Consumer Assistance Program of the federal government.
Using your mental health coverage
For detailed information regarding your coverage, contact your human resources department or insurance company. Here are a few things to think about:
- Examine your coverage to discover if it makes use of provider networks. When seeing an out-of-network provider, consumers are usually expected to pay higher out-of-pocket charges. For a list of in-network providers, contact your insurance company or go to their website.
- Inquire about copays. A copay is a fee that your insurance company requires you to pay for a specific service out of pocket. You might have a $20 copay for each clinic visit, for example. Copays for mental health visits may have been higher in the past than for most medical visits. For insurance plans subject to the parity law, this should no longer be the case.
- Inquire about the amount of your deductible. A deductible is the amount of money you must pay out of pocket before your health insurance will cover anything. For example, depending on your deductible, you may have to pay $500 or $5,000 out of pocket before your insurance company will start paying claims. Your deductible should apply to both mental and physical health coverage as a result of the parity statute.
- Speak with your service provider. When you contact to make an appointment with a mental health professional, make sure to ask if your insurance is accepted. Also, inquire as to whether he or she will bill your insurance company directly and you would just be responsible for a copayment, or if you will be responsible for paying in full and then submitting a claim to your insurance company for reimbursement. Inquire about your provider’s payment policy if he or she does not accept insurance.
What can I bring to Pine Rest?
Because patient storage space is limited, do not bring in huge numbers of stuff. Protective containers should be used to store dentures, retainers, hearing aids, and eyeglasses. Never wrap them in tissue since they may be thrown away.
- All current medications, or a complete list of all prescriptions, as well as the phone number for the pharmacy
What is the mental health?
Our emotional, psychological, and social well-being are all part of our mental health. It has an impact on the way we think, feel, and act. It also influences how we deal with stress, interact with others, and make decisions. Mental health is vital at all stages of life, including childhood, adolescence, and maturity.
If you have mental health difficulties, your thinking, mood, and behavior may be altered over the course of your life. Many factors play a role in mental illness, including:
Mental health issues are frequent, but there is assistance. People with mental illnesses can improve, and many will recover entirely.
What are the 7 main mental disorders?
- Generalized anxiety disorders, social anxiety disorders, panic disorders, and phobias are examples of anxiety disorders.
- Borderline personality disorder, narcissistic personality disorder, and antisocial personality disorder are examples of personality disorders.
What are the 4 types of mental illness?
In the DSM-5, there are almost 300 mental disorders included (Diagnostic and Statistical Manual of Mental Disorders). This is a handbook that health practitioners use to diagnose and recognize mental illness.
The diagnosis of mental disorder is sometimes contentious. In the medical world, there has been much discussion concerning what constitutes a mental illness. Our civilization and culture can influence the definition, yet most mental diseases occur in all countries and cultures. This implies that they are shaped not only by societal norms and expectations, but also by biological and psychological factors.
What should I not tell a psychiatrist?
We’re not going to mince words. When it comes to talking with your therapist, there aren’t many things that are off-limits. Instead, it’s critical to approach your sessionsvirtual or otherwisewith an open and vulnerable perspective.
With that in mind, we’ll go over some of the most prevalent statements that therapists hear from their clients, as well as why they can be impeding your progress.