Insurance Needs to Treat Mental Health Fairly

Health plans need to treat mental health fairly

In 2008, Congress passed the “Mental Health Parity and Addiction Equity Act,” with a focus on making mental-health and substance-abuse treatment on par with medical care. Today, amid an opioid epidemic, spikes in both childhood trauma, autism spectrum identification, and suicide rates, Americans are still struggling to get access to treatment.

There is a solution to these issues, and fortunately it is based on the free-market principle of supply and demand.

Milliman, a risk-management and health-care-consulting company, released a national study through a coalition of mental-health and addiction-advocacy organizations. The researchers at Milliman examined two large national databases containing medical-claim records from major insurers covering nearly 42 million Americans (in all 50 states and the District of Columbia) from 2013 t o 2 015 .The key takeaways were (1) behavioral care was four to six times more likely to be provided out-of-network than medical or surgical care and; (2) insurers paid primary-care providers 20 percent more for the same types of care than they paid-addiction and mental healthcare specialists, including psychiatrists.

This type of reimbursement philosophy and out-of-network benefit structure has created an extremely fragmented niche market of mental-health and substance-abuse providers. Many of these providers refuse to contract with insurers, resulting in not enough therapists and other trained specialists to meet patient demand.

The scarcity of mental-health providers who accept insurance creates a landscape that is difficult to navigate for some of the most vulnerable patients and thus drives these patients to the highest and most expensive level of care — the emergency room.

Mental Health America, the oldest mental-health advocacy organization in the United States, recently released its annual the State of Mental Health in America 2017 report. The report utilizes data from 15 national databases and surveys collected during 2015 to provide a portrait of mental health in America. In a comparison of states, Arizona received an overall ranking of 49, just above the state of Nevada and just below the state of Mississippi.

Even with this ranking, our state’s Medicaid agency, the Arizona Health Care Containment System, is still regarded as one of the most innovative state Medicaid agencies in the United States. Our Medicaid behavioral healthcare delivery system provides a variety of mental health services, although the focus on treatment rather than supportive services still has a way to go to improve outcomes.

If you are not considered low-income, you are most likely insured through your employer and the chances are, your mental health and/or substance use issues are not being screened, identified,monitored or managed.

It is long overdue that all health-insurance plans provide full parity for mental- health and substance-use disorder services. Screening, prevention and early intervention for mental illness and substance-use disorders must be an integrated part of everyone’s health and wellness.

Overall, parity will increase access to care by attracting more providers to contract in-network, thereby improving outcomes, curbing health-care costs and ultimately eliminating mental-health stigma.

Justin Bayless is the president and CEO of Bayless Integrated Healthcare.

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