Affordable Care Act
6:10 am
Tue November 12, 2013

The Magic Pill, Part 2: Getting Fair And Equal With Your Mental Health Care

This story is the second installment in a five-part series on mental health care. Click here for the entire series.

For years, having health insurance didn't necessarily mean you were covered for mental healthcare.  But, recent regulations from The White House aimed to fix that.  Think it can work?

The Magic Pill, Part 2: Getting Fair And Equal With Your Mental Healthcare

A stuffed version of Edvard Munch's "The Scream," found in Mark Komrad's office.
Credit Mary Rose Madden

Sarah Crimmins, 34, struggled with a mental disorder; she was working with different doctors and through the side effects of medication, and she was fighting with her insurance company to get the coverage she thought she bought.  She says having insurance brought along problems she never foresaw, “Insurers can be particular about how long you stay in the hospital or what drugs you take or what drugs they want you to take.  That’s their preference. Their preference doesn’t make a whole lot of sense to your treatment.”

Like many with psychiatric disorders, she had to meet higher deductibles, higher co-pays and lower lifetime limits. And her doctors were subject to more aggressive reviews of her treatment. 

Mark Komrad, a psychiatrist in private practice and chair of ethics at Sheppard Pratt Hospital, says it’s not unusual to receive calls from managed care insurance companies.  He said they’d call everyday and ask questions like, “I know you came in yesterday feeling suicidal, but today? No? Ok, you need to wrap it up.  Tomorrow, you need to get to outpatient.” 

Dr. Steven Sharfstein, president and CEO of Sheppard Pratt, says the managed care for mental health and substance abuse treatment is much more stringent than for other ailments. And he explains that the monitoring, known as “utilization reviews,” makes a huge difference in a patient’s care, “this can be done in a good way, but sometimes it’s not and people end up fighting for their coverage.”

But under the 2008 Mental Health Parity Law and recent regulations that clarified it, patients and families battling mental health problems or substance abuse will not face more aggressive reviews than they would for medical or surgical treatments. Eliminating the discrimination, creates a fairer playing field, says Sharfstein, “it enables people to advocate for their benefits in a way that is not arbitrary as it used to be.”  Patients and their families will have more economic protection.

Now, it’s not often that patients, providers, advocates, and insurance companies agree on something. But they all liked The Parity Act.

Pamela Greenberg is president and CEO of The Association for Behavioral Health and Wellness.  Her group represents insurance companies that provide coverage for substance abuse and mental disorders to 2.5 million Marylanders. She says her group has supported parity for years and calls the law “beneficial” adding, “any co-pays will be the same for mental health and addiction as they are for medical– that’s the huge step forward – helps with access.” 

Couple that with the Affordable Care Act, which makes mental health and substance abuse treatment “an essential health benefit” required in new health insurance plans, and tens of millions will benefit, Greenberg says.  “It’s a great opportunity,”  she adds.  But don’t think the work is done for mental healthcare, “parity is not the panacea for all the issues we have in the behavioral health field.”  Greenberg and others say many questions still need answers. For example, “How will parity be measured?”

And Adrienne Ellis, an advocate with the Mental Health Association of Maryland, says they have concerns about getting the care to the people who need it.  Ellis says there’s a real danger that there won’t be enough therapists and psychiatrists to help those seeking treatment, armed with their new insurance cards empowered by new laws.  But until now, she says, they didn’t even have access on paper.