| There are many facets to the world of mental health, | | | | treat mental illness? Insurance companies tend to be |
| especially when it comes to health insurance and | | | | somewhat wary of mental health claims due to the |
| finding adequate coverage for a variety of afflictions | | | | increase of fraudulent claims. When Medicare looked |
| and disorders. We've put together some answers to | | | | for fraud in the community mental health centers last |
| some of the more common questions revolving | | | | year, it barred 80 of them in nine states from |
| around these topics for you below. | | | | participating in the program. |
| Do most health plans include mental health coverage? | | | | The Health Care Financing Administration (HCFA), |
| The answer, simply put, is yes. The vast majority of | | | | which administers Medicare, knew something was |
| insurers and health plans cover at least a limited | | | | amiss when the average yearly cost for each senior |
| amount of mental health care. | | | | getting mental health services jumped from $1,642 in |
| According to a recent employer survey published in | | | | 1993 to more than $10,000 by 1997. |
| the journal Health Affairs: •91 percent of small | | | | Medicare administrator Nancy-Ann DeParle contended |
| firms (10-499 employees) and 99 percent of large | | | | at the time that 90 percent of the patients had no |
| firms offer mental health and substance abuse | | | | mental illness serious enough to qualify for special |
| coverage in their most used medical plans. | | | | treatment. |
| •Mental health and substance abuse | | | | That being said, it's straightforward to understand why |
| coverage was included in 87 percent of indemnity | | | | there is trepidation on the part of health insurance |
| plans, 88 percent of HMOs, 97 percent of Point of | | | | providers. |
| Service (POS) plans and 93 percent of Preferred | | | | What mental conditions are typically covered, and not |
| Provider Organizations (PPOs). | | | | covered by health plans? Generally speaking, a health |
| It is commonly acknowledged today, in 2006, that most | | | | plan pays for only those services included in the plan's |
| employees who have employer-based health | | | | list of covered services. In the case of mental health |
| insurance have access to mental health coverage, and | | | | services, inpatient and outpatient treatment are most |
| many of the employees who don't have coverage | | | | often covered by health plans. |
| have simply chosen not to join an employer's plan that | | | | However, there is a continuum of services between |
| includes mental health services. | | | | inpatient (mental health clinic) and outpatient care that |
| Does mental health coverage cost more? Yes, this is | | | | effectively treat many mental disorders and are often |
| generally the case. There are limits to mental health | | | | more cost-effective than inpatient care at a mental |
| coverage and the reason why most employers | | | | health clinic. |
| impose limits is due to cost. Estimates vary widely of | | | | These intermediate services include nonhospital |
| how much more mental health coverage costs. Here | | | | residential services, partial hospitalization services, and |
| are some results from some studies: | | | | intensive outpatient services such as case |
| •A 1998 study sponsored by National | | | | management and psychosocial rehabilitation. |
| Advisory Mental Health Council (NAMHC) Parity | | | | Psychosocial rehabilitation includes pharmacologic |
| Workgroup, a division of the federal National Institute of | | | | treatment, social skills training, and vocational |
| Mental Health, estimated that mental health services | | | | rehabilitation. |
| would add less than 1 percent to the cost of a health | | | | Such services are covered by approximately half of |
| insurance policy for an HMO. | | | | employer-sponsored health plans. Prescriptions. Are |
| •A 1998 study by Mathematica estimated a | | | | they covered? Coverage of prescription medications is |
| 3.6 percent increase across all plans, with a range of | | | | also important in providing access to treatment for |
| 0.6 percent increase for HMOs up to a 5 percent | | | | mental health disorders. And, on a positive note, |
| increase for fee-for-service plans. | | | | Prescription medications are nearly always covered by |
| •A 1997 analysis by the actuarial firm Milliman | | | | health plans (U.S. Department of Labor, 1996; 1998), but |
| & Robertson for the National Center for Policy | | | | this coverage is sometimes limited by formulary |
| Analysis, examining the cost of a typical mental health | | | | restrictions. |
| mandate (not specific legislation), concluded that mental | | | | Check with your healthcare provider for the exact |
| health services parity legislation tends to drive up costs | | | | details on what applies to you and your family with |
| by 5 percent to 10 percent. With regard to mental | | | | regard to your specific circumstances. |
| insurance in general, how do insurance companies | | | | |