Make the Insurance Companies Pay

Parity in reimbursement for those with mental illness seemed in reach with passage of the Mental Health Parity and Addiction Equity Act of 2008.  Advocates built on that success by ensuring that the Affordable Care Act of 2010 mandated conformity with that earlier law.

But, many people have found that access to treatment is no easier than it was before those reforms. The American Psychiatric Association, for example, charged that “it is well documented that most health care directories of psychiatrists purportedly available to treat plan members are woefully inaccurate and create ‘phantom networks.'”A Maryland study found that less than 40 percent of the psychiatrists listed in plan directories were actually accepting that plan’s insurance.

Researchers at Johns Hopkins Bloomberg School of Public Health found two major problems: financial disparities such as different co-pays or deductibles for mental and physical health services and more stringent requirements for “prior authorizations” from insurers for those services. Obscure and confusing interpretations of “medical necessity” have also enabled insurers to deny coverage.

Congressperson Joseph Kennedy III introduced the Behavioral Health Coverage Transparency Act of 2015 (HR4276) to address these problems.  The act would require insurance companies to disclose information to federal regulators about rates and reasons for denials for mental health claims versus medical/surgical denials.  Federal agencies could perform random audits of plans and consumers could submit complaints to a central online clearinghouse.  Contact Congressperson Mark Pocan to urge his support.


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