Mental Health Parity
Mental Health Insurance Parity
Is your group health plan in compliance with the federal parity law?
Mental health parity is the recognition of mental health conditions as equivalent to physical illnesses. Historically, many health insurance companies limited benefits for mental health to a much lower level than those available for physical conditions. With the passage of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPAEA) in 2008, mental health parity is the law of the land.
Despite passage of this landmark law, people still face pervasive barriers in accessing needed care including:
- Denial rates for inpatient and outpatient mental health care that are more than twice those for other types of medical care;
- Limits in access to needed psychiatric medications, particularly antipsychotic medications;
- Serious shortages of psychiatrists, therapists and other mental health professionals in health insurance networks;
- High out of pocket costs (co-pays, deductibles, co-insurance); and
- Lack of information necessary to make informed decisions about plans.
Read NAMI’s 2015 report: A Long Road Ahead: Achieving True Parity in Mental Health & Substance Use Care.
We need your help to make compliance with the federal parity law a reality. it is important that the federal agencies charged with enforcement of parity protections hear from persons with mental illness and family members about their experience in confronting ongoing practices in health insurance and limitations that apply only to mental health benefits that are likely violations of MHPAEA. Parity violations include plans more strictly managing or denying mental illness treatment services more than other services covered by the plan. More information may be found at http://parityispersonal.org/
What can I do to help? Persons with mental illness and family members are urged to share parity violation stories which illustrate barriers to access non-discriminatory coverage for mental illness treatment services. Be sure to tell your personal story and attach any relevant documents (if available) such as a denial letter, summary of benefits or other materials provided by the health plan. Following are some examples of common problems with parity that other providers or consumers have registered:
- Outpatient sessions are being limited by utilization review (also known as medical necessity review) and this is not being done for medical and surgical conditions.
- Provider reimbursement rates are too low, so the provider has to offer services out-of-network and the patient has to pay a higher out of pocket for their treatment.
- The insurance company has labeled treatments as “experimental” and therefore are refusing to pay for those treatments, leaving the patient to pay 100% out of pocket, or go without.
- The insurance company says that a plan does not cover residential treatment or intensive outpatient care.
- The insurance company says that a plan does not cover inpatient or residential treatment unless it is provided in an acute care hospital, but most of the treatment providers are non-hospital based facilities.
- A patient has requested from their insurance company the reason why they have been denied care and the insurance company does not respond to requests for further information, or they refuse information about what they do for medical and surgical care, or they refer the patient to an enormous website that is confusing or hard to navigate.
A thorough study of the barriers to achieving parity in mental health benefits for those with private insurance coverage in Kansas was completed in 2006 by a Task Force of the Governor’s Mental Health Services Planning Council. Click here to download a copy of the report.
A major obstacle to getting true parity in mental health benefits for those with private insurance is the lack of official complaint data at the Kansas Insurance Department (KID) from policy holders who have been denied adequate, appropriate, or timely treatment. NAMI Kansas encourages consumers and family members to make formal complaints through appropriate channels and we encourage providers to encourage their clients in this regard. Please consider sharing a copy of your complaint with NAMI Kansas so that we might better represent the needs of policy holders on this issue.”
To initiate a complaint with KID, put your concerns in writing and address them to the KID using the following contact information or click here to go to their online complaint form.
Consumer Assistance Division – Complaint/Inquiry
Consumer Assistance Hotline: 800-432-2484 (in Kansas only)
Telephone: 785-296-7829 (local)
Fax: 785-296-5806 TTY/TTD: 877-235-3151