Guest Column: Insurance companies must step up mental health coverage

35

With the annual open enrollment period launched and Michiganders searching for their best health insurance options for 2023, one key topic continues to dominate health care discussions: mental health care.

According to the National Council for Mental Wellbeing, 1 in 5 adults (52.9 million) in the U.S. experienced mental illness in 2020, including 1 out of 3 young adults ages 18-25. Suicide is the second-leading cause of death among people aged 10-34.

In Michigan, an estimated 1.3 million people have some form of mental health condition.

Lack of treatment

We are facing a growing mental health crisis in our country. More people are seeking treatment, but many are ineligible for free or reduced care, don’t have the coverage they need or are unable to pay the high cost of care. A shocking 54% of adults with mental illness are receiving no treatment.

Much of the blame is due to insurance policies that are woefully inadequate when it comes to caring for mental health.

While improvements can be made in both public and private health care, private insurance plans often feature lackluster coverage, low reimbursement rates for caregivers and a very narrow set of mental health services. The result is hundreds of thousands of our fellow Michiganders are not receiving the comprehensive mental health care they need and deserve, and some receive no treatment at all.

Residents living with anxiety and depression often are denied treatment, leading to disruptions and serious, long-term impacts on their work, lives and families, including bankruptcy.

Michigan residents are supportive of more affordable and accessible levels of mental health coverage: Research published this summer by Consumers for Quality Care showed that 89% of Michigan voters believe insurance should cover a wider range of mental health care and associated prescriptions.

Treat health equally

Mental health must be considered on an equal basis to physical health care — but that’s not currently the case.

For example, you may need one annual visit to your primary care doctor, but the average course of treatment for outpatient psychotherapy is six sessions. Current parity laws, which set similar per-visit co-pays for mental health and physical health care, would result in the patient paying six times greater in copays for a standard course of mental health care vs. physical health care.

In addition, a range of standard and long-accepted, evidence-based services may be needed by mental health patients, from respite to home-based services, case management, crisis residential, drop-in centers, or assistance in securing housing and employment. These are benefits many Michiganders receive through public programs like Medicaid, yet are mostly absent from private plans.

Even when coverage is provided, it’s often a miracle to find a mental health care provider — the result of very low reimbursement rates that insurance companies pay to providers. Instead, people trying to access mental health care will often find that the mental health provider list is a “ghost network,” meaning the providers do not accept the patient’s insurance or have very long wait lists.

Another factor is massive growth in alcohol and drug addiction in recent years. Coverage for these issues varies greatly, with key medications often excluded, making it difficult for treatment to be accessed. Standard treatments that should always be an option are often unavailable, and because of the stigma of addiction people are often afraid to fight for their right to care.

Then, there’s the secret many don’t even realize: Many mental health providers do not even take insurance and work on a cash-only basis. Roughly half of the nation’s psychiatrists do not take insurance at all due to the low reimbursement rates.

If you are lucky enough to find one that will accept your insurance policy, they may be booked out for months. So, if you have urgent mental health needs, you are on your own. It’s an unsustainable situation for those struggling with and trying to address mental health and substance abuse challenges.

Real parity

For Michigan residents searching for their next insurance policy during open enrollment, reading the fine print on the mental health coverage may be an eye-opener. The companies offering these policies must be committed to making the changes needed to increase transparency and achieve “real parity” for mental health. To achieve parity:

  • Co-pays must be reduced for mental health care
  • Networks must be expanded to increase mental health providers accepting new patients
  • Reimbursement rates to providers need to be increased so they can afford to see clients with insurance
  • A full range of standard and long-accepted mental health services must be offered to patients

If this is achieved, all Michigan residents will have access to care that they truly deserve, a fighting chance at recovery, and an opportunity to lead a full and healthy life.

Robert Sheehan is CEO of the Community Mental Health Association of Michigan.

Facebook Comments