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Who is commonly left out of mental health coverage even if they have insurance?

Health Care and Health Insurance
by Heather Robinson
Mental health access is low when compared to healthcare coverage, even for those with insurance.
Mental health access is low when compared to healthcare coverage, even for those with insurance.

Mental health is becoming a larger priority to Americans and more people are interested in maintaining a healthy mental state. The stigma surrounding common mental illnesses like depression and anxiety is lessening and, as a result, Americans are seeking more mental health medical attention from professionals such as therapists, psychiatrists and social workers.

However, mental health care is not easily accessible to all populations and those who could benefit from mental health attention may not receive it due to the out-of-pocket cost of these services.

Who is commonly left out of mental health coverage? Why is mental health not covered in many health insurance policies, leaving even those with insurance to wonder if they can afford these necessary doctor visits? We'll answer those questions in this article.

Provider networks

Mental health is just as important as physical health, and one often impacts the other. However,  health insurance coverage often has mental health disparity. A Milliman Research Report shows that "a behavioral health office visit is over five times more likely to be out-of-network than a primary care appointment."

This is a staggering statistic and forces many people to either pay sizable charges or not seek help at all. And Americans struggle with mental illnesses — about 51.5 million people, according to the National Institute of Mental Health. Even if they do not have a diagnosable illness, seeing a mental health professional can be a good maintenance practice, similar to a physician's yearly check-up.

Coverage

According to GoodRx, health insurance plans that offer mental health coverage must support behavioral health treatment, mental and behavioral health inpatient services, and substance use disorder treatment. However, each state and insurance company has its own policies.

In 2008, the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) was passed. It requires all large-group employer insurance plans to cover mental health services the same as they cover medical services. Note that it only applies to large-group insurance plans, which leaves the opportunity for individual and small-group plans to not offer mental health support. Luckily, the Affordable Care Act of 2010 requires those insurance plans to offer coverage for mental health.

Despite this, care still remains an issue. The Kaiser Family Foundation's (KFF) research indicates that access is an issue, even for those who have health insurance. Their survey data shows that 18% of people say they could not get time off of work to seek mental health attention. Additionally, 1 in 4 of KFF's surveyed adults "who did not get the mental health care say the main reason why was because they could not find a provider."

Discrimination in mental health coverage

The mental health crisis that was already prevalent in America, paired with the COVID-19 pandemic, made it even more clear that there are populations that do not receive adequate mental health care. For example, the Centers for Disease Control and Prevention found that there was a significant increase in suicide attempts among adolescent girls since May 2020 and continues into 2021. 

Despite the national laws requiring mental health parity, an NPR article dives in deep on why equivalent coverage is still an issue for some. "Insurance companies can easily circumvent mental health parity mandates by imposing restrictive standards of medical necessity," Meiram Bendat, a lawyer, told the NPR reporter.

Here are some of the demographics that are most likely to face discrimination when it comes to mental health coverage even if they do have health insurance.

Chronic mental disorders

Medicare beneficiaries can only have up to 190 days of lifetime inpatient psychiatric hospital care, which greatly impacts those with chronic mental conditions. In general, those with a history of mental health issues have a more difficult time getting insurance coverage because it can be difficult to prove their condition.

Language

Americans who are not fluent in English may have difficulty finding a psychologist who is fluent in their first language or understands their culture due to network issues.

Public workers

According to The New York Times, public workers could have a more difficult time finding mental health care because "health plans for state and local workers can opt-out of the federal law requiring them to treat mental health like other medical conditions."

Insurance companies should do their best to communicate to their beneficiaries about their mental health coverage, remove barriers when possible and focus on full mental health parity for nonquantitative treatments as well as quantitative treatments.

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