Mental parity leaves insurers unclear of coverage requirements


Although the Mental Health Parity and Addiction Equity Act has been in place since 2008, many questions remain regarding how it affects insurers and whether they cover psychiatric care. In fact, lawsuits filed against insurers argue the companies still fail to offer equal coverage of mental health services, reported The New York Times.

The federal law requires insurers cover mental illness similarly to chronic illnesses like cancer or multiple sclerosis. Although the law clearly prevents insurers from placing time limits on psychiatric treatment, it doesn't specify exactly how insurers must guarantee parity for psychiatric care.

Making matters worse, federal officials still haven't written the law's final regulations that cover insurers, creating inconsistent interpretations of how the law actually impacts those insurance companies.

For example, Anthem Blue Cross denied claims for psychiatric treatment for one member. "You had not been getting better in a significant way," Anthem said in a letter to the 14-year old member last year. "It does not seem likely that doing the same thing will help you get better."

And UnitedHealth is dealing with a lawsuit alleging it doesn't provide equal coverage for mental health conditions, instead requiring strict medical criteria and pre-authorizations not needed for primary care, FierceHealthPayer previously reported.

In the UnitedHealth case, a member with generalized anxiety disorder sought twice-weekly therapy treatment costing $250 a visit. But UnitedHealth stopped paying for the therapy sessions because the member was "generally functioning quite well" and should manage his condition on his own or through community resources.

"The use of multiple weekly therapy sessions is limited to acute exacerbations of illnesses or in the context of a clinical urgent situation in order to prevent a higher level of care," UnitedHealth said in a letter.

The problem is the lack of accepted medical evidence for mental health treatments. "It's very different from the approach to a bypass procedure or a hip replacement," Karen Ignagni, CEO of America's Health Insurance Plans, told the Times. And it's no surprise why insurers are reluctant to cover these treatments--mental health costs about $113 billion each year.

Obama administration officials say by of the year they will write the remaining rules under the mental parity law. And insurers say they would welcome those regulations. "We think it may create better clarity," an Aetna spokesperson told the Times.

To learn more:
- read the New York Times article

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