By Michael Ollove
Under federal law, insurance plans that cover mental health must offer benefits that are on par with medical and surgical benefits. Twenty-three states also require some level of parity.
The federal law, approved in 2008, and most of the state ones bar insurers from charging higher copayments and deductibles for mental health services. Insurers must pay for mental health treatment of the same scope and duration as other covered treatments; they can’t require people to get additional authorizations for mental health services; and they must offer an equally extensive selection of mental health providers and approved drugs.
Federal and state regulators have an easy time keeping track of copayments and deductibles, and insurers typically follow those rules. Compliance with parity requirements for the actual delivery of medical services is another story.
The responsibility for enforcing parity laws is divided between the federal government and the states. Under the federal parity law, states are supposed to police commercial insurance plans and Medicaid, although the federal government can step in if it determines states aren’t doing enough. The federal government is responsible for overseeing self-insured plans.
But among states, only California and New York consistently enforce the rules, mental health experts say. As a result, Americans with mental illness and addictions “don’t have a right to mental health and addiction treatment that the law promises,” said Emily Feinstein of CASAColumbia, a nonprofit organization focused on drug addiction.
In a report released last month, the National Alliance on Mental Illness found that patients seeking mental health services from private insurers were denied coverage at a rate double that of those seeking medical services. The report also found that patients encountered more barriers in getting psychiatric and substance use medications.
One major roadblock is that health insurers usually do not disclose policies for determining if a treatment is medically necessary. Without that information, it is difficult for regulators and consumers to determine whether the denial of coverage is warranted. Although the federal parity law requires insurers to divulge that information to patients and doctors upon request, critics and plaintiff attorneys say insurers are still keeping too much hidden and states aren’t diligent in forcing disclosure.