There are still certain stigmas attached to individuals suffering from mental and behavioral health issues, even now in the 21st century. One would like to think that with the wealth of information we have available at our fingertips, those suffering from various mental health conditions would receive more equal treatment; however, the reality is that this is not always the case. While one would also expect at least the medical community to be more understanding than the general public, that is not always the case either. Behavioral and mental health issues are often left unresolved, cast aside or glanced over, especially when health insurance companies are involved.
As a patient, please make sure that you understand what your insurance policy offers for both medical and mental health coverage. With the introduction of new laws over the last several years, if your insurance company offers medical AND mental health coverage, it must be at the same level of care. For example, your policy can not state that you pay a $10 copay for a medical appointment and a $20 copay for a mental health appointment. Both copays must be the same. This also applies to the number of appointments or hospital visits you are allowed each year, the amount of your deductibles and authorization requirements, just to name a few. There will be times when your mental health provider has to call your insurance company for “authorization” of service. When this happens, you may be called upon to be your own advocate!! You can help by understanding your illness and your insurance policy or by providing documentation of coverage to your provider when asked. If you need help understanding any of the details of your insurance plan, please see your Human Resources representative or call your insurance company directly.
As a healthcare provider, keeping up with the new laws and rules, is paramount. If you think that you are having an issue with a patient’s insurance, it is important that you document the parity issue and keep good records for follow up. You must follow through with all appeal levels afforded to you so that your patient can appeal on their behalf. Understand the contracts for which you are credentialed and what the provider manuals for those companies say, will help you to stay within the timeframe allotted for authorizations, appeals and concurrent reviews. Request plan documents or certificates of coverage on each of your patients. This will give you much needed insight as to their plan details and often highlight parity issues right away between their medical and mental health plans. Enlist your patients to advocate on their own behalf. Nothing is more powerful than having the patients’ voice heard, first hand.
With proper awareness, and continual education, the stigmas and lack of parity towards individuals seeking treatment for mental health and behavioral health should continue to diminish as we push towards the future.
More information available from the Substance Abuse and Mental Health Services Administration.