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Report: Insurers fall short of behavioral health coverage

Benefits, networks and drug costs all inadequate, National Alliance on Mental Illness says

Insurance companies fall well short of providing mental health and substance abuse coverage, says a new report from the National Alliance on Mental Illness (NAMI).

After surveying 2,720 customers and analyzing 84 plans that were either employer-sponsored or sold on health insurance exchanges, NAMI determined that problems range from lack of mental health providers to a lack of information about mental health coverage.

In particular, the report found that almost 33 percent of consumers received denials of authorization for mental health or substance abuse treatment from their insurer. Exchange plans had denial rates nearly twice the rate for other medical care.

Last month, a study published in journal Psychiatric Services found that about 25 percent of exchange plans violate a federal mental health parity law that requires insurers to offer equal benefits to physical and mental healthcare, FierceHealthPayer previously reported.

NAMI also found that insurers' provider networks lack behavioral health providers. "The networks looks good on paper, but when you actually try to find a provider you end up with a lot of roadblocks," Sita Diehl, NAMI's director of state policy and advocacy, told U.S. News & World Report. "Narrow networks are an egregious problem."

Plus, high out-of-pocket costs for prescription drugs likely discourage members from receiving such needed treatment. For example, more than 50 percent of analyzed plans covered less than 50 percent of anti-psychotic medications.

"With mental illness, that's the beginning of a slippery slope, and your life can come completely apart," Diehl said. "It makes sense to pay at the front end and make it affordable."

Based on the report's findings, NAMI called on the U.S. Department of Health and Human Services to scrutinize plans' behavioral health coverage. In particular, HHS "needs to regulate health plans and costs so consumers don't end up sharing this much of the cost," Diehl says. "Without the regulation, Congress should work to decrease out of pocket costs."

Additionally, NAMI wants insurers to be required to publish updated, accurate lists of provider networks, and to establish simple procedures for filing complaints with insurers about mental health and substance abuse coverage.

"It's an improvement in terms of access, but it's not the improvement we had hoped for in terms of coverage yet," Diehl says. "We have more work to do to achieve parity."

To learn more:
- here's the NAMI report (.pdf)
- read the U.S. News & World Report article

Related Articles:
Study: Exchange plans violate mental parity laws
Let's bring behavioral, mental health into the mainstream
'60 Minutes' accuses insurers of denying mental health claims
Mental health access lacking in many states