The first ray of hope: More people are spending money to treat their troubled minds. During the coronavirus pandemic, clinician visits increased by 39 percent and spending by adults with employer-sponsored insurance jumped 54 percent, according to a new study in JAMA Health Forum. The researchers examined the claims of about 7 million adults from March 2020 to August 2022.
These statistics reveal a nation determined to feel better. Working through mental health and substance use issues is often painful and expensive. People who seek care should be lauded: Investing in their own health pays social and economic dividends.
As the demand for care increased during the pandemic, telehealth made it easier to connect. Unfortunately, insurance companies often offset this progress by imposing more expensive premiums and deductibles, making care less accessible. The JAMA researchers warn that insurers may begin rejecting telehealth claims outright now that federal public health emergency measures have ended. This would be shortsighted. Failing to treat the mind as well as body racks up tens of billions of dollars in health-care costs for people annually — money patients will look to get back by filing insurance claims.
The second positive sign is that the Biden administration is trying to make it more difficult and more expensive for insurance companies to discriminate in this way. It is closing loopholes in the Mental Health Parity and Addiction Equity Act that insurers use to avoid covering behavioral health care as comprehensively as physical health care.
These efforts won’t immediately make therapists available to the 164 million Americans living in areas with too few mental health providers. Over time, though, a stronger Parity Act should swell provider ranks by ensuring they are paid fairly.
Proposed regulations would require equitable reimbursement rates for behavioral and medical care and prohibit companies from blocking treatment by demanding prior authorizations from a doctor. Data and transparency are also part of the improvement plan. Insurers would have to identify and compare the factors they use to determine the medical necessity of treatments for both mental health and physical health. And to comply with the Parity Act, an insurer would have to report how many patients see providers in its plan, not just list the therapist names on its website.
Failure to report the data would carry a fine of at least $100 a day. But there is a catch: Insurance companies only have to share their reports by request. It will be up to the Labor Department, employers and individuals to hold insurers to account. This will take more time, money and public education about patient rights.
Fortunately, more people are defending their right to dignity and mental health care in the courts. This is hope No. 3.
One class-action suit has been dubbed the “Brown v. Board of Education” case for the mental health parity movement. Plaintiffs recently celebrated a small victory in their decade-long fight against the insurance behemoth United Behavioral Health. They contend the company broke plan members’ trust by determining that their treatments were not medically necessary based on internal guidelines written to save money, not to meet generally accepted standards of mental health and addiction care.
On Aug. 22, a federal appeals court ruled that some plaintiffs could reprocess their claims, reversing part of its March 2022 decision. The attorneys general of Illinois, Rhode Island and Connecticut slammed that 2022 decision, saying it could embolden other insurers to deny treatment for addiction, worsening the country’s opioid epidemic.
In a clearer legal win, on Aug. 25, Yale students accepted an out-of-court settlement for their claim that the university discriminated against them because of their mental health conditions. Current and former students accused school officials of visiting them while they were hospitalized for suicide attempts and other mental health issues, and threatening to kick them out of school if they didn’t leave voluntarily.
Yale did not admit fault but did agree to make it easier for students to return from medical leave and to study part-time while on leave. The university also agreed to revise its training for mental health professionals, share data about students on medical leave and pay the plaintiffs’ legal fees.
Even before the pandemic, mental health conditions cost employers up to $51 billion a year in lost productivity. When the coronavirus emptied classrooms and offices, many people were left to deal with their anxiety and depression alone. Some companies and schools like Yale couldn’t or wouldn’t recognize that even overachievers can be disabled by mental or emotional stress, and that penalizing them makes matters worse.
As more people break their silence, whether in therapy or in the courts, the costs of ignoring or denying mental health problems grow. To consolidate these hopeful trends in spending, policy and law, schools and companies now need to spot and fix internal practices that harm their students and employees. Crucially, they also must provide insurance plans that comply with the Parity Act, report violations to the state agency overseeing health insurance and teach their own staff how to appeal an insurance plan’s denial of care.
The more complaints, the more data state and federal officials have to hold insurers accountable, and the more the public — including judges — understand the costs of discriminating against people with mental health and addiction issues.
Americans recognize their mental health needs greater attention. Next, they need to recognize their legal right to fair treatment and demand the gatekeepers get out of their way.
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