Mental and physical health are inextricably linked, yet healthcare systems have historically treated them as fundamentally different. This plays a key role in mental health stigma, but it can also make it more difficult to access mental health care.
Insurers can no longer exclude mental health conditions from coverage, or assign different copays and deductibles to mental health conditions.Federal laws have required some form of equal coverage for mental and physical health conditions—called mental health parity—since 1996. The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPAEA)—which was passed in 2008 and fully enacted in 2012—toughened regulations, requiring insurers to cover mental health conditions at similar levels to the coverage they offer for physical health conditions. This means that insurers can no longer exclude mental health conditions from coverage, or assign different copays and deductibles to mental health conditions. mental illness
Legal parity certainly brings us closer to equitable access to mental health care, but it’s only a part of the picture.
MENTAL HEALTH PARITY ACT: WHAT IT REQUIRES
Federal mental health parity laws require most insurance plans to treat mental health conditions like physical health conditions. Parity laws for insurance coverage of mental health treatment mandate that:
Insurers can’t require pre-authorization or a referral for mental health services if they don’t require them for physical health care.
Insurers can’t set different deductibles, copays, or out-of-pocket maximums for mental health care.
Insurers can’t refuse to cover a condition solely because it is a mental health condition.
Insurers must treat mental health emergencies just like physical health emergencies, including by covering admission to psychiatric treatment facilities when necessary.
Insurers can’t force a person to try a less expensive treatment first, if they do not require them to do this for physical health conditions.
Insurers can’t place arbitrary limits on how long a person can stay in a psychiatric treatment facility.
Some plans, including those that existed prior to the new law, most Medicare plans, and plans that are non-compliant with the Affordable Care Act, are not covered by the newest parity laws.
WHY FEDERAL LAW DOESN’T ESTABLISH TRUE PARITY
Research consistently shows that insurers violate health insurance parity laws.Research consistently shows that insurers violate health insurance parity laws. Consumers may not know these laws exist. Even when they do, enforcing them is difficult and requires extensive time and knowledge. Regulators may not fine insurers who violate the law, and the fines may be so small that they do not deter future violations.
Some common violations include:
Refusing to pay for residential treatment.
Requiring a referral for mental health care.
Charging more for behavioral health medications.
Not covering the most commonly used behavioral health medications.
Stricter interpretation of mental health coverage requirements.
Additionally, the law does not mandate full equitable access to or coverage for mental health care. It can be more difficult for people to find quality mental health care, especially in rural areas. Clinicians may also continue to stigmatize or ignore people with mental health conditions, resulting in care delays. A 2017 study, for example, found that people experiencing mental health emergencies wait almost four times as long in emergency departments as those with physical health issues.
While mental health parity laws may mean that clinicians are more likely to get reimbursed for services, these laws can also create significant hurdles to reimbursement, and make running a practice more challenging. Some of the most prevalent issues providers face include:
Lower reimbursement rates. A 2017 analysis found that reimbursement rates for mental health services are far lower, even when clinicians have similar training or provide similar services.
Difficulties with health insurance panels. Getting onto a health insurance panel can be a bureaucratic challenge. This, coupled with low reimbursement rates, means that many clinicians choose not to join provider panels.
Diagnostic and other requirements. Many insurers require that mental health providers assign a specific diagnosis prior to treating a client. When clients seek help for serious issues such as domestic violence or a recent trauma, they may not have a diagnosis. This forces clinicians to either over-diagnose or deny care.