Planning The Unpredictable

Part of the bailout plan was the Mental Health Parity Act. It basically says that mental health illnesses should be treated as a medical problem and have equal coverage under your health insurance. A lot of insurance companies either don’t cover mental health at all or have a limit of what is covered. At first, this seems like a great thing. Finally, mental health illnesses are recognized as a real health condition.

The problem comes again with the wording:

‘(4) AVAILABILITY OF PLAN INFORMATION- The criteria for medical necessity determinations made under the plan with respect to mental health or substance use disorder benefits (or the health insurance coverage offered in connection with the plan with respect to such benefits) shall be made available by the plan administrator (or the health insurance issuer offering such coverage) in accordance with regulations to any current or potential participant, beneficiary, or contracting provider upon request. The reason for any denial under the plan (or coverage) of reimbursement or payment for services with respect to mental health or substance use disorder benefits in the case of any participant or beneficiary shall, on request or as otherwise required, be made available by the plan administrator (or the health insurance issuer offering such coverage) to the participant or beneficiary in accordance with regulations.

So, the insurance companies get to make the determination if mental illness is serious enough that treatment is a medical necessity. I was speaking with a mental health professional regarding this new act and she said insurance companies are already qualifying the mental illness as “serious” or not. If they consider it “serious”, the patient will get more care. She asked the insurance company what was consider “serious” and they told her that they were unable to provide that information. They told her to bill them and they would decided if it was serious. She had very little hope for this bill to make a positive impact on the lives of American’s.

If someone suffing from a mental illness goes into remission, will the insurance companies decided it’s no longer “serious” until the next time they aren’t in remission? It is an interesting question.

Never a dull moment…

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