HomeHealthHealth CareGuest Column: Insurance companies must step up mental health coverage

Guest Column: Insurance companies must step up mental health coverage

With the annual open enrollment period launched and Michiganders looking for their best health insurance options for 2023, one major topic continues to dominate health care discussions: mental health care.

According to the National Council for Mental Wellbeing, 1 in 5 adults (52.9 million) in the US had a mental illness in 2020, including 1 in 3 young adults aged 18-25. Suicide is the second leading cause of death among people aged 10 to 34.

In Michigan, one estimated at 1.3 million people have some form of mental health problem.

Lack of treatment

We are facing a growing mental health crisis in our country. More people seek treatment, but many don’t qualify for free or reduced care, don’t have the coverage they need, or can’t afford the high cost of healthcare. A shocking 54% of adults with mental illness receive no treatment.

Much of the blame is due to insurance policies that are woefully inadequate when it comes to mental health care.

While improvements can be made in both public and private health care, private insurance plans often offer mediocre coverage, low reimbursement rates for health care providers, and a very limited number of mental health services. As a result, hundreds of thousands of our fellow Michiganders are not getting the comprehensive mental health care they need and deserve, and some are getting no treatment at all.

Residents living with anxiety and depression often go untreated, leading to disruptions and serious, long-term consequences for their work, life and family, including bankruptcy.

Michigan residents favor more affordable and accessible levels of mental health coverage: research published this summer by Consumers for Quality Care showed that 89% of voters in Michigan believe that insurance should cover a wider range of mental health care and associated prescriptions.

Treat health equally

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Mental health should be considered on an equal footing with physical health, but that is currently not the case.

For example, you may need a visit to your primary care physician once a year, but the average treatment course for outpatient psychotherapy is six sessions. Current parity laws, which set comparable per-visit co-pays for mental health and physical health care, would result in the patient paying six times more copays for a standard mental health versus physical health care course.

In addition, psychiatric patients may require a range of standard and long-established, evidence-based services, from respite care to home care, case management, crisis care, drop-in centers or help securing housing and employment. . These are benefits that many Michiganders receive through public programs such as Medicaid, but are not usually found in private plans.

Even when there is coverage, it is often a miracle to find a mental health provider – the result of very low reimbursement rates that insurance companies pay to providers. Instead, people trying to access mental health care will often find that the list of mental health providers is a “ghost network,” meaning that the providers do not accept the patient’s insurance or have very long waiting lists.

Another factor is the enormous growth of alcohol and drug addiction in recent years. Coverage for these problems varies greatly, often excluding important medications, making it difficult to access treatment. Standard treatments that should always be an option are often unavailable and because of the stigma of addiction, people are often afraid to fight for their right to care.

Then there’s the secret that many don’t even realize: Many mental health providers don’t even take insurance and operate on a cash-only basis. About half of the country’s psychiatrists are not insured at all due to low fees.

If you’re lucky enough to find one that accepts your insurance policy, they can be fully booked for months. So if you have urgent mental health needs, you’re on your own. It is an intolerable situation for those struggling with and trying to deal with mental health and substance abuse issues.

True parity

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For Michigan residents looking for their next insurance policy during open enrollment, reading the fine print on mental health coverage can be an eye-opener. The companies offering these policies should be committed to making the changes needed to increase transparency and achieve “true equality” for mental health. To achieve parity:

  • The personal contribution must be reduced for mental health care
  • Networks need to be expanded to ensure that mental health providers accept new patients
  • Reimbursement rates to providers need to be increased so they can afford to see customers with insurance
  • A full range of standard and long-established mental health services should be offered to patients

When achieved, all Michigan residents will have access to the care they truly deserve, a chance for recovery, and a chance to live full and healthy lives.

Robert Sheehan is CEO of the Community Mental Health Association of Michigan.

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