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June 03, 2019
Rosemary Gomes spent nearly all her life’s saving amounting up to $221,000 on treating her daughter Samantha. Sam, as she was fondly called by her mother, suffered from major depression leading to suicidal ideation. What made the situation worse for Gomes was that despite having insurance, she had to spend her savings. The reason – her insurance company did not think it was “medically necessary “for her daughter to be admitted into a rehab facility. Hence, her treatment was not covered under the family’s health plan. Gomes was lucky she had the money. But what about the millions of other Americans out there who were not so lucky?
Eleven years ago the Mental Health Parity and Addiction Equity Act of 2008 was passed which required the insurance companies to provide equal coverage for mental health illnesses as for physical health complications. The Affordable Care Act 2014, popularly known as Obamacare, went a step further and made it mandatory for insurance companies to cover addiction treatment also along with mental health.
But alas, the situation on the ground is completely different. According to several real life incidents and research projects, equality in mental health insurance laws is not being practiced at the ground level. For example, in places like Colorado, insurance companies are in fact paying mental health professionals nearly 30 percent less than what they pay other professionals from the medical field.
Reasons for this inequality
There are various reasons which can be attributed to this difference between the enforcement of insurance laws for mental health illness and other physical health disorders. In fact, mental health care was deemed separated from the rest of health care many decades ago when the first law on health care was established in the 1960s. Also what is “medically necessary” has no concrete definition. Shortage of mental health professionals and most of them accepting direct payment from patients further contributes to this gap.
Another phenomenon contributing to this disparity is “ghost networking” which basically means that an insurance company, on papers, provides a long list of mental health providers in its network. But in reality, these facilities hardly accept or admit patients.
On top of all these problems, the federal and state regulators and enforcement agencies are already overburdened with many other things in addition to overseeing the enforcement of parity laws.
Dr. Benjamin Miller, a mental health professional said that the reason there is a difference in health insurance for physical and mental health is due to the government’s initial health policies, which are being rectified now.
Good news is on its way
While we celebrate the 70th anniversary of the Mental Health Month in May, lawmakers in the U.S. are fighting hard to bring parity in health insurance. U.S. Congressman Donald Norcross, vice-chair of the Bipartisan Addiction Task Force, along with U.S. Representatives Joe Courtney and Ann Kuster, chair of the Bipartisan Addiction Task Force, have recently introduced the Parity Enforcement Act 2019. The main objective of the bill is to bring equality in enforcement of insurance plans for mental health and substance abuse disorders with physical health for workers who receive health insurance through their employers. If the bill is passed, then the insurance providers will be held accountable for violating the Mental Health Parity and Addiction Equity Act of 2008.
Talking about the importance of the bill, congressman Norcross said that America was losing more people due to the opioid epidemic every year than it did in during all the years of the Vietnam War. He also highlighted the fact that even deaths due to suicide were on the rise in the country. Further, mental health equality is the law of the land. Unfortunately till now most insurance companies were able to get away with violations because the enforcement mechanisms were neither in place nor were enforced adequately or effectively. He also said that the best way to stop the increase in addiction and overdoses was by ensuring that all Americans had access to effective mental health and addiction treatment. Norcross said that the new law will empower the Department of Labor (DOL) to ensure that employer sponsored insurance plans strictly followed parity laws.
Adding to Norcross’s comments, Congressman Kuster said that at this stage when the opioid crisis is affecting each and every part of the nation, the government will not let insurance companies take advantage of people suffering with substance abuse disorders. He added that insurance companies will not be allowed to get away with the violations anymore.
The good news is that the bill is receiving support from all quarters, including the opposition parties and non-political groups. Earlier, even the Secretary of Labor, Alexander Acosta had expressed his support towards the bill while testifying before the Congress. This proposal was also included as a recommendation by president Trump’s Commission on combatting Drug Addiction and the Opioid Crisis and also in the report from ex-president Obama’s Mental Health and Substance Use Disorder Parity Task Force.
According to the 2017 National Survey on Drug Use and Health (NSDUH) report, approximately 46.6 million people aged 18 and above suffered from a form of mental health illness in the U.S. with one out of every five adult living with a form of mental illness in the past year. Just like it is important to take care of one’s physical health, it is equally important to take care of one’s mental health as well. Therefore, it is important to identify symptoms of mental health disorders and seek treatment as soon as possible.
If you or a loved one is battling mental health disorders and is looking for licensed mental health facilities in California, then get in touch with the Invictus Health Group. We can connect you with credible residential mental health treatment centers. For more information about residential mental health treatment, call our 24/7 helpline 866-548-0190 and speak to a member of our team. You can also chat online to a representative for further assistance.