Guest host, Jane Clayson of the On Point radio station, facilitated a much needed conversation on insurance companies complying with the federal parity law. The conversation consisted of Kaiser Health news correspondent, Jenny Gold; attorney and founder of Psych-Appeal, Meiram Bendat; and health economist, Devon Herrick.
Gold highlighted the Mental Health Parity and Addiction Equity Act of 2008 and how insurance carriers have found sneakier ways to limit cost associated with behavioral health care. Carriers have decreased their quantitative treatment limitations (eg. spending limits, co-payments) and increased non-quantitative treatment limitations (eg. pre-authorizations, medical necessity reviews), which are much harder to spot embedded violations of the law. One of the main issues cited by Gold is the lack of parity enforcement. Enforcement is split among state insurance commissioners, the Department of Health and Human Services, the Department of Treasurer and the Department of Labor. If the parity law was proactively enforced, consumers would be relieved of the burden of monitoring their coverage and having to spot violations and file complaints.
Approximately one out of six adults in the United States have a mental health condition. Unfortunately, many do not access services. The most common response to why insured consumers with behavioral health needs were not accessing care is because of cost. A California representative shared with the Kaiser Health News correspondent that these findings point to mental health as a second class benefit.
Meriam Bendat told the story of Michael Cayman whose son was diagnosed with several complex mental health conditions requiring frequent meetings to see a psychiatrist. According to his son’s psychiatrist, it was medically necessary for Cayman’s son to be seen 13 times a month. After a review of medical necessity by his insurance carrier, monthly meetings reduced from 13 to 2 a month, ultimately, resulting in the hospitalization of Cayman’s teen son.
Economist Herrick described how insurance carriers tackle financial barriers by using step-therapy or a “fail first” method when approving and denying care for behavioral health. In addition, he noted that private insurance are taking the same approach as the federal government with providing accountable care to its members. He stated, “carriers want to provide the right care, at the right time, in the right setting.” However, the flaw is that the right time, care or setting is subjective when it comes to behavioral health. The right time for a carrier’s psychiatrist could be too late for the consumer.
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