Sunday, November 08, 2009

Ch-Ch-Ch-Changes!


The times they are a-changing....

Next year, the new parity laws for mental health will go into effect: health insurance must cover mental disorders the same when it covers other medical illnesses, without limits on visits, or higher co-pays. It remains to be seen how this will play out-- my fear has been that the response might be to simply eliminate mental health benefits from insurance policies. From the American Psychological Association (sorry, it was a pdf file so there is not a direct link) on the Wellstone-Domenici Parity Act of 2008 :

The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (The “Wellstone-Domenici Parity Act”) will end health insurance benefits inequity between mental health/substance use disorders and medical/surgical benefits for group health plans with more than 50 employees. Under this new law a group health plan of 50 or more employees that provides both physical and mental health/ substance use benefits must ensure that all financial requirements and treatment limitations applicable to mental health/substance use disorder benefits are no more restrictive than those requirements and limitations placed on physical benefits. This means that equity in coverage will apply to all financial requirements, including lifetime and annual dollar limits, deductibles, copayments, coinsurance, and out-of-pocket expenses, and to all treatment limitations, including frequency of treatment, number of visits, days of coverage and other similar limits.

We don't know yet how this will play out...I hate that little clause "...that provides both physical and mental health/substance use benefits..." because it's left as an option. Would we tolerate a health insurance plan that excluded pneumonia or cancer? And it would be so nice if one could see a psychiatrist without pre-authorization (do you need pre-authorization to go to the doctor for your back pain or headaches or fever?) but my guess is that won't play out, since surgeries require pre-approval in many plans.

The New York Times has an optimistic piece on upcoming parity. Leslie Alderman writes in "In Anxious Times: Help for the Mind as Well as the Body:" Alderman writes:

The law’s changes can be good and not so good. Good, because you might have access to more care. Not so good if there are new requirements, like getting precertification for coverage, that place additional barriers to getting treatment, says Kaye Pestaina, vice president of health care compliance for the Segal Company, a benefits consulting firm.

“Employees should make sure their employer provides information to them about any new medical management rules,” Ms. Pestaina said.

Okay, so the House just passed the President's Health Care Reform bill (all 1,990 pages of it). What might this mean for psychiatry and how will parity play out in a newly-insured American?