Mental health parity may finally become a reality

I worked for Cigna for five years and saw all of this unfold on a daily basis.  Sometimes it was blatant, and other times it was a bit more confusing.  I completely agree that if a person has benefits and has not used them, then regardless of the level of care, especially if it is being recommended by an M.D., that person should be allowed to receive care for their issues.  If they have no insurance, that's another complicated matter.  

The one hang up, and I think this article pointed it out, is that when a person does not get the care needed, and they end up getting tossed around the system, getting "lower levels" of care, such as outpatient or intensive outpatient to save on cost, when the reality of it is that if they were simply allowed to receive a residential program from the beginning, maybe the years of hassle, other failed treatments, and expense could have been avoided.  Unfortunately, once you've maxed your benefits for the calendar year, forget it, your done!  And there is an abundance of elephant dung sized health care plans to see to it that you exhaust your benefits as fast as possible.  In other words, if your benefits renew calendar year starting in January, and your actively seeking help for you mental health or substance abuse  issues, you could conceivably max out by February, and spend the rest of the year without help or treatment, unless you keep paying out of pocket.  

This issue could easily be a 900 volume tome, and I could ramble on at great length, but I guess from the insurance perspective, they only do what is necessary to keep a human being alive and functioning (feed themselves, dress themselves, bathe)  at the bare minimum of expense, which I think is where the term "medical necessity" stems from.  And why the insurance companies have the power to determine this over the M.D. treating the patient, I will never know.  Mental health and substance abuse are not as easy a fix as mending a broken arm, or stitching up a wounded knee, they're much more long term, and progress can move very slowly.  If I may be allowed to be a bit of a hippie about it, my hope is that if we the human species have any hope of progressing further, and sustaining life on this planet, the cost, no matter what ridiculous financial figures they produce, would ultimately become a true non-issue.

...bit of rant I know, sorry, just wanted to get that out and add it to the discussion.  Thanks. 

There is an important technicality here that needs to be better explained.  Minnesota already has a mental health parity law so Minnesotans who buy health coverage from anything other than large employers were already covered by the parity law.

This new law was only for large employers who are exempt from all state mandates like mental health parity.  And, most important for these large employers, they don't actually buy insurance.  They are self insured so it isn't actually the insurance company issuing the denial, it's a third party administrator (many times an insurer who is running a TPA) that is implementing the coverages laid out by the employer.

So the complaints about the insurers not paying, should be more appropriately leveled at the employers who were not willing to pay.

Finally, there is a very important reason for claims denials.  It's to keep costs low.  While the call for better coverage is certainly worthy and nobody can deny it is very much needed, the problem is that it is extraordinarily expensive and most of these people want the treatment, but they want somebody else to pay for it.   The 'somebody elses' of the world would likely be more willing to pay for the care, if there was a way to make the care less expensive. 

You cannot get something for nothing. Insurance companies probably do not cover these mental maladies because they are difficult to define, diagnose, and successfully treat. Forcing insurance companies to do so at the point of a government gun is evil and will probably result in less coverage for the mentally ill and higher insurance costs for us all.

What is the impact of depression treatment persistence on total healthcare costs?  Read:http://www.healthcaretownhall.com/?p=5702

the lines between illness and health are very blurry, and political.  my own doctor has told me to lose 60 pounds.  I cannot find success-- despite spending thousands of my own money on various plans and groups.  I would like to try total immersion (similar to the article's subject, a residential treatement plan).  However just like the other ways I've tried, insurance won't cover a dime of it. 

My point is this:  I am basically sort of healthy, but my asthma, depression, and blood pressure are getting worse, and I would be more productive and happier if I could lose weight.  But, Big Insurance doesn't see this as a problem, and won't pay to try to get me "healthier". 

It's not the middle-health people like me who get care, it's the extremely low-health people who get care, just like government benefits--  the middle class pay pay pay their taxes, but the low-income receive the majority of benefits.

wow

GREAT news!

Great article.  I hope people will start paying more attention to the laws that protect our most vulnerable people.