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