Two-to-One Odds against Consumers with Behavioral Illnesses
Imagine you have diabetes and your insurer won’t pay for insulin. Instead, you have to pay out of pocket or face blindness, or even death? Now imagine you learn that people like you with diabetes were twice as likely to be denied treatment compared to people with other medical problems. Sound unfair to you?
For millions of people who need treatment for drug and alcohol problems or mental illness, inequity is a reality.
Behavioral health discrimination in health insurance is once again in the spotlight. Health insurance denials for substance use and mental health care in private insurance plans were nearly twice those for other medical care in the last year, according to a report released last week by the National Alliance on Mental Illness (NAMI). NAMI is one of our partners advocating for more fair treatment for people living with chronic behavioral health problems.
For years, people with behavioral health issues, their loved ones and advocates have pushed for a more equitable system, one in which substance use and mental health treatment is covered equally, or at parity with, other forms of medical treatment under health insurance plans. This work resulted in the 2008 passage of the Mental Health Parity and Addiction Equity Act, a federal law requiring many health insurance plans to follow parity rules, meaning that if they offer mental health and substance use disorders benefits, they must cover them equally to other medical benefits. The Affordable Care Act (ACA) has extended these protections to more health plans. New federal regulations were issued in late 2013 for private plans and proposed regulations came out last week for Medicaid.
NAMI surveyed nearly 3,000 behavioral health consumers (thanks to those of you who participated!) and analyzed 84 insurance plans in 15 states. The takeaway? While more consumers than ever should have access to health plans that require behavioral health parity as a result of the ACA and the federal parity law, consumers are often left without the treatment they so desperately need.
In addition to the high rate of substance use and mental health coverage denials, the survey’s highlight other common problems with parity implementation:
- Many insurance networks have far too few substance use and mental health providers
- Discriminatory drug tiering, when insurance companies make medication for certain conditions more costly for the consumer, creates barriers to needed for substance use and mental health disorders
- Consumers do not have enough information about behavioral health coverage to compare health plans and choose a health plan that meets their needs
What can we do?
- In our work with consumers, we can learn to recognize what a parity violation looks like and who to contact about behavioral health plan discrimination.
- Find out how key states across the country are stepping up parity enforcement.
- Connect with state agencies and policymakers about the impact of parity on real people and to offer examples of strong state enforcement.
If you’re looking for even more ideas, you’re in luck! Keep your eye out for new Community Catalyst resources on behavioral health parity enforcement in the coming months. It’s time to leverage the letter of the law to make behavioral health equity a reality in our health system. Together we can make change – let’s work to keep the spotlight on parity.