Opinion | Health insurance keeps your mind sick and your wallet empty

The Mental Health Parity and Addiction Equity Act that Congress passed in 2008 was supposed to prevent this situation by pushing for the equal treatment of minds and bodies. Clearly, the law doesn’t work. Congress and the Biden administration must strengthen it. Health insurers should also recognize that it is in their financial interest to improve coverage of mental health and addiction treatment.

The University of Chicago survey released by the Bowman Family Foundation reflects the experiences of 2,794 patients who have commercial, Medicaid or Medicare insurance. As the United States grapples with epidemics of opioid abuse, violence, isolation and suicide, these are life and death matters for many Americans.

The labyrinthine US healthcare system is dizzying to navigate. Even when people have insurance, the doctors and other health care professionals they need to see often won’t accept their coverage. Patients are forced to choose between debt and despair.

Mental health specialists acknowledge this problem, but say they often fail to join insurance networks because plans place unacceptable limits on care, drown them in paperwork to justify treatments, and reimburse too little to cover their costs. A study of insurance claims showed that, as of 2014, online psychiatrists received 13 to 20 percent less reimbursement than other doctors providing the same mental health services in the same network. Another study showed that in 11 states, reimbursement rates in 2017 for outpatient visits were more than 50% higher than for behavioral outpatient visits.

Eighty percent of patients in employer-sponsored health plans surveyed by University of Chicago researchers said they were out of the behavioral health care network all the time. Only 6% did so for physical health care.

Psychiatrists, psychologists and other behavioral health care providers who do not accept insurance rates reflect their education and experience as well as market demand. This leaves patients with a choice: pay high prices or forgo treatment altogether.

There’s this big gap between what the market is saying is the relevant price and what insurers are paying, David Lloyd, chief policy officer of the Kennedy Forum’s patient advocacy group, told me. It is profoundly unfair. You have a different set of access for the more affluent who can afford to pay out of pocket, even if it’s a stretch for them.

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Staying in-network is cheaper once your insurance starts paying out, but finding a behavioral health specialist is difficult when insurance company websites list only a few names or include providers who have dropped out of the plan. 40% of respondents to the University of Chicago survey said they had to contact four or more network providers to get an appointment.

Patients who do manage to seek treatment often experience problems getting reimbursed. According to the University of Chicago study, 52 percent said they were denied coverage three or more times for behavioral assistance. The figure was 33% for physical assistance.

The situation is worse in rural areas because few suppliers practice there. In 2021, one-third of Americans lived in areas without enough mental health providers. More than half of US counties did not have a single psychiatrist.

This means that people often turn to general practitioners for support with addiction, depression and other mental health issues. But 87% of people in the recent survey said that wasn’t enough – they needed help from a specialist too.

How can these many problems be solved? Through concerted action by the government and insurers.

The Biden administration is off to a good start in recognizing the importance of mental health. Launched the 988 Suicide and Crisis Hotline, is investing hundreds of millions of dollars in training and incentives for doctors to work in rural and underprivileged communities, invest in scientific research, and fund wellness programs to reduce health care burnout first line. healthcare professionals.

Next, the administration needs to strengthen the Mental Health Parity and Addiction Equity Act with clearer guidelines on how to comply with it. At present, the law does not specify what exactly parity is for reimbursement rates and supplier networks. Insurers take advantage of this vagueness to justify all but the most egregious injustice, Lloyd said. Clarity would allow state and federal insurance regulators to enforce the law. Lloyd said the Office of Management and Budget is reviewing proposed regulations to do so. Separately, the proposed Parity Enforcement Act making its way through Congress would strengthen the law by allowing the Labor Department to issue fines for violations.

Insurers, for their part, should recognize that they have a powerful incentive to improve their coverage: the close relationship between physical and mental health. Untreated addiction and chronic mental illness can cause or exacerbate costly physical ailments. In 2017, people with both behavioral and physical health conditions incurred an additional $406 billion in health care costs, according to estimates by Milliman, a risk management and health advisory firm. By ensuring their beneficiaries get adequate mental health care, insurers can help reduce the costs of all health care by saving up to $69 billion annually, Milliman estimates.

At a minimum, insurers should include more providers who treat behavioral health and pay them as much as providers who treat physical health. To attract more mental health and addiction specialists to underserved areas, insurance companies would need to increase their reimbursement rates and cut red tape such as licensing approvals to see certain providers.

They would also be smart to reimburse providers more for embracing the collaborative care model, in which a primary care physician works together with a mental health care manager and a consulting psychiatrist. This integrated care reduces stigma and increases access to mental health and addiction treatment, and holds the promise of saving big money.

The US healthcare system is costly to families and to the country. Morally, improving access is the right thing to do for Americans in pain. Financially it makes sense too.