Posted by Phillipa on December 10, 2014, at 19:59:43
Medscape Medical News > Psychiatry
APA Ups Efforts to Raise Awareness of Mental Health Parity Law
Megan Brooks
December 09, 2014
The American Psychiatric Association (APA) has launched a new tool to help raise awareness that mental health parity is the law and that mental health insurance coverage must be on par with health insurance for physical illness.In its ongoing efforts to raise awareness that mental health parity is US law, the association has distributed a poster entitled Fair Insurance Coverage: It's the Law to psychiatrists and other mental health providers in the hope that they will post it in their offices and waiting areas and share it with colleagues.
"This is a simple, nonintrusive way to get information about the law to patients and tell them how they can take steps to make sure they are being treated fairly," Paul Summergrad, MD, APA president and psychiatrist-in-chief, Tufts Medical Center, Boston, Massachusetts, told Medscape Medical News.
"This is an issue we have worked very hard on for a very long time. By any reasonable estimate, 20% to 25% of the US population is going to have some form of mental health condition over the course of a year, whether it's a mom who has depression, or a kid with an anxiety disorder, or an elderly person who has dementia. These are things that affect families throughout the country," said Dr Summergrad.
The parity poster reminds patients that the Mental Health Parity and Addiction Equity Act (MHPAEA) prohibits insurers from discriminating against people who have a mental illness, including a substance use disorder, and that coverage for a mental health issue must be on par with that of a physical health problem, such as heart disease, diabetes, and cancer.
But many patients may not know what constitutes a violation of their rights under the law.
Written for a lay audience, the poster clearly explains a patient's rights under the law and what steps to take when they suspect a violation. There is a place on the poster for healthcare providers to write their state insurance commissioner's name and number for patients.
Specifically, the poster tells patients the following:
You are entitled to the treatment your physician says is necessary for your mental health or substance use disorder. Your health plan cannot require you to fail first at less-expensive treatments if it does not have the same "fail first" requirement on all other illnesses covered by your plan.
With few exceptions, your copayment or coinsurance for your mental health benefit should not be higher than it is for other medical care, and you should have only one deductible and out-of- pocket maximum that covers all of your healthcare.
When you visit a psychiatrist for medication management and for psychotherapy on the same day, you should pay only one copayment.
You should have access to an "in-network" mental health care provider who is qualified to treat your condition and can see you in a reasonable amount of time at a location accessible from your home.
Mental healthrelated visits or treatment should not require preauthorization unless your plan requires preauthorization for most other medical care.
The number of visits or hospital days should not be limited, unless similar limitations apply to most other medical illnesses under your plan.
Your health plan should pay even if you do not complete the treatment or you have failed to complete a prior recommended course of treatment.
Your health plan is required to provide you with a written explanation of how it evaluated your need for treatment; why it denied the claim; and the basis for its conclusion that the plan complies with federal law.
You have the right to appeal your plan's decision about your care or coverage. You have the right to appeal the claim with your plan and with an independent review organization. (Patients are advised to check with their state insurance commissioner's office.)
If you have an out-of-network benefit in your plan and see an out-of-network psychiatrist, the health plan should reimburse you for a portion of the amount you paid for the visit. If the amount you are reimbursed is significantly less than the amount the health plan pays to other doctors who are out of network, this may be illegal. You can see what doctors are paid by checking the explanation of benefits you receive from your plan.
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