Minding Your Health – New Rules Require Parity for Mental Health Coverage

Despite the controversy and confusion surrounding the Affordable Care Act, which some call Obamacare, one thing is clear: The law’s provisions and recent updates raised mental health treatment to the same level as treatment for other medical issues.

The original act required that mental health and substance abuse treatment must be included in all plans sold on public health-care exchanges. This was part of the 10 essential benefits. Then, on Nov. 8, 2013, the final rules from the Mental Health Parity and Addiction Equity Act of 2008 were issued (www.hhs.gov/news/press/2013pres/11/20131108b.html). Full implementation of this act had been delayed by political differences.

The importance of mental health insurance coverage cannot be overstated. Statistics show that 1 in 4 adults experienced a mental health condition within the last year. For 1 in 17 adults, the condition was serious. However, almost 50 percent of youth and more than 60 percent of adults do not seek care or go without.

For the LGBTQ population, the statistics are more problematic. LGBTQ adults are more likely to experience psychological distress than their heterosexual counterparts and they are more likely to need medication for emotional health issues. Transgender adults and LGBTQ youth are more likely to attempt suicide. The statistics are even more troubling for LGBTQ people of color.

With parity, individuals can now receive the mental health care they need to improve those statistics. To help ensure that plans honor parity, the National Alliance on Mental Illness (NAMI) posted several resources on their website, www.nami.org. To find them, click on the “NAMI Advocacy” tab.

Included are these five signs that your plan may be violating parity requirements:
1. You have to pay more or you get fewer visits for mental health services than for other kinds of health care.
2. You have to call and get permission to get mental health care covered, but not for other types of health care.
3. You have been denied mental health services because they were not considered “medically necessary,” but your plan does not answer your request for the medical necessity criteria they use.
4. You cannot find any in-network mental health providers that are taking new patients, but you can for other health care.
5. Your plan will not cover residential mental health or substance use treatment or intensive outpatient care, but will cover similar treatment for other health conditions.

NAMI published the “Parity Toolkit,” which guides insurance plan participants through the appeal process if they believe their plan has violated parity requirements. Another resource is the Parity Implementation Coalition (www.parityispersonal.org). The 13 member groups of this national organization include the American Psychiatric Association, the American Academy of Child and Adolescent Psychiatry, and NAMI. It works to end discrimination for those who seek mental health services.

While providers and consumers continue to adjust to the changing insurance marketplace, the important thing to remember is that mental health services are considered essential and equal to physical health.

Kyle Danner is an organizer for the LGBT-Affirmative Therapists Guild of Greater Kansas City. He is pursuing a master’s degree in counseling and guidance at the University of Missouri-Kansas City.

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