By Walter Armstrong
WEDNESDAY, Oct. 7 (Health.com) — By the time the gargantuan $700 billion Wall Street bailout bill was passed and signed last Friday, it contained a landmark piece of legislation that just might improve—surprise!—the quality of our lives. Dubbed the Mental Health Parity and Addiction Equity Act, the law forces most insurance plans to offer the same coverage for mental problems as they do for physical ailments.
No longer can insurers discriminate against people with bipolar disorder, say, or alcoholism, by providing fewer benefits than they do for broken bones and breast cancer. Longstanding restrictions on mental health and substance-abuse treatment will be lifted, ranging from higher deductibles, co-pays, and out-of-pocket expenses to the automatic cutoffs (typically at 30) for hospital days and therapy sessions.
Hard times, good timing
The timing couldn’t be better, of course, with our moods growing darker daily along with the economic outlook. But while the financial rescue was passed in a single week, mental health parity took 18 years to gain critical mass.
“There’s been a revolution in the science and treatment of mental health in the past two decades,” says Andrew Sperling, the director of federal legislative advocacy at the National Alliance on Mental Illness (NAMI), who helped push the bill through Congress starting with its first draft. As evidence accumulated of the biological basis for diseases ranging from schizophrenia to obsessive-compulsive disorder to addiction, yielding targets for the development of effective drugs, the managed-care industry could no longer justify controlling costs by relegating mental health issues to second-class status.
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Depressed people cost money
They also did the math. “Employers and insurance companies came around to seeing it as cost-effective,” Sperling says. “Expenditures are much less than was feared, and the increase in productivity is substantial.” Originally estimated as a 10% cost hike, the parity price tag attached to federal and state programs is calculated to be anywhere from 0.4% (Congressional Budget Office) to 2% or 3% (World Health Organization).
The rise of so-called managed behavioral health companies, which large insurers pay to deal with their plan’s mental health and substance-abuse items, also upped industry acceptance, according to an official at Blue Cross/Blue Shield, who asked not to be named. “Under managed behavioral health, the cost-sharing for these benefits can be managed, and that’s why we didn’t scream bloody murder over the bill,” he says.
While the bill may be a boost for the dying art of long-term psychotherapy, eager analysands should take note: The law is not a mandate and therefore leaves employers free to offer no mental health or substance-abuse benefits at all. And it doesn’t apply to businesses with fewer than 50 employees or to individual health plans. That leaves 31 million Americans out in the cold.
Relief in 2010, if you're lucky
Still, it’s progress. Increased benefits should start kicking in around January 2010, according to Sperling. But some consumers will be left twiddling their thumbs a lot longer than that. “The new law will not interrupt an existing contract,” he says, “and some extend all the way out to 2013 or so.”
And don’t expect your health plan to become your new best friend. Expect push-back on big-ticket items like inpatient substance-abuse treatment. Whether insurers will bankroll detox programs with extensive follow-up care or boutique mental health facilities, such as those for teenage drug abuse or alcohol treatment, remains to be seen. Prior authorization is key, so check with your plan manager before emergency strikes.
Finally, one problem the new law leaves untouched is the generally lousy treatment that managed-care plans offer their members. Customer service will continue to deny or delay reimbursements, especially for out-of-network care, driving us crazy with their claims that our claims were never received or are missing information or are under review (still). But that’s payback.