INSURANCE

In 2008, the Mental Health Parity and Addiction Equity Act was passed and health insurance issuers were required to have equitable mental health or substance use disorder benefits compared to medical heath benefits.

However, since mental health professionals were not required by the law to be part of an insurance network, patients using out-of-network service  providers ended up paying more for services. This is because the mental health professional could experience a lower reimbursement rate from an insurance company than if they were not associated with an insurance network and charged clients directly.  Consequently, some professionals remained independent of insurance networks.

From a survey completed by the National Alliance on Mental Illness, out of 3,081 respondents, 73% stated that they had an in-network mental health therapist, but 91% stated they had an in-network medical specialist. This shows that one quarter of respondents did not have an in-network mental health therapist.

While this is not fair to those seeking mental health treatment, there are some options for insurance providers that will make this journey easier for those seeking treatment.

The first option is to provide information about mental health benefits. This will allow the individual to see what exactly the insurance provider covers, who patients are able to go to and any limitations there might be. This information would ideally be available to the individual as they are looking at various insurance plans and deciding which one will benefit them the most.

Another option is for the insurance provider to expand their mental health networks. As mentioned above, often times mental health professionals are unable to partner with insurance providers due to the low reimbursement rates. Since these rates are so low, the mental health professionals would not be able to make enough money to make a living. If more insurance providers raise these reimbursement rates, it will attract more mental health professionals to join the providers and allow more individuals to have access to affordable mental health care through insurance coverage.

One last option is for insurance providers to cover out-of-network care when no in-network options are available. If there are no in-network mental health options available to an individual, the insurance provider should cover the costs for the individual to go to an out-of-network option so they are still able to receive treatment.

Written by: Shannon Finn