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Although federal law requires insurers to provide the same access to mental and physical health care, these companies have been caught, time and again, shortchanging customers with mental illness — restricting coverage and delaying or denying treatment.

These patients — whose disorders can be chronic and costly — are bad for business, industry insiders told ProPublica.

“The way to look at mental health care from an insurance perspective is: I don’t want to attract those people. I am never going to make money on them,” said Ron Howrigon, a consultant who used to manage contracts with providers for major insurers. “One way to get rid of those people or not get them is to not have a great network.”

There are nowhere near enough available therapists in insurance networks to serve all of the people seeking care. And although almost all Americans are insured, about half of people with mental illness are unable to access treatment. […]

It is often the insurers, not the therapists, that determine who can get treatment, what kind they can get and for how long. More than a dozen therapists said insurers urged them to reduce care when their patients were on the brink of harm, including suicide.

* Vox last year…

A recent survey of nearly 2,800 US patients found that 40 percent of patients who had sought in-network mental health care had to make four or more calls to find a provider who would see them — compared to just 14 percent for physical health care. More than half of patients said they had had a claim for mental health care denied three or more times, compared to about one-third who had the same experience with physical services […]

According to a Milliman research report, US patients were five times more likely to use an out-of-network provider in 2017 for both inpatient and outpatient mental health care than they were for all other medical services. One in five office mental health visits was with an out-of-network provider. Reimbursement rates for primary care were 20 percent higher than they were for mental health care, on average. And those disparities actually got worse over the course of the 2010s.

All in all, the US has made it hard to find a mental health provider and hard to pay for their services. (Even if your provider does cover some of an out-of-network bill, the patient’s share will be higher than it would have been in-network). And this is with the parity law in effect.

* Sen. Karina Villa has a bill in Assignments that aims to address this issue in Illinois. From the most recent amendment…

Provides that for all group or individual policies of accident and health insurance or managed care plans that are amended, delivered, issued, or renewed on or after January 1, 2026, or any contracted third party administering the behavioral health benefits for the insurer, reimbursement for in-network mental health and substance use disorder treatment services delivered by Illinois providers and facilities must be equal to or greater than 141% of the Medicare rate for the mental health or substance use disorder service delivered (rather than on average, at least as favorable as professional services provided by in-network primary care providers). Removes language providing that reimbursement rates for services paid to Illinois mental health and substance use disorder treatment providers and facilities do not meet the required standard unless the reimbursement rates are, on average, equal to or greater than 141% of the Medicare reimbursement rate for the same service. Provides that, if the Department of Insurance determines that an insurer or a contracted third party administering the behavioral health benefits for the insurer has violated a provision concerning mental health and substance use parity, the Department shall by order assess a civil penalty of $1,000 (rather than $5,000) for each violation. Excludes health care plans serving Medicaid populations that provide, arrange for, pay for, or reimburse the cost of any health care service for persons who are enrolled under the Illinois Public Aid Code or under the Children’s Health Insurance Program Act from provisions concerning mental health and substance use parity. Makes other changes. Effective immediately.

The bill was referred to Assignments in April, but picked up five co-sponsors in the Senate this month.

posted by Isabel Miller
Monday, Aug 26, 24 @ 1:52 pm

Comments

==It is often the insurers, not the therapists, that determine who can get treatment,==

This is one of the biggest things wrong with our healthcare system. It’s set up as a for-profit enterprise. Healthcare should not involve profits. Period.

Comment by Demoralized Monday, Aug 26, 24 @ 2:22 pm