Not all healthcare issues are equally covered in our healthcare system. The recently amended Mental Health Parity Rule means to increase access to quality mental healthcare.
Does my insurance company cover therapy?
Many of us have this question, and it should be a simple one to answer. Unfortunately, for most of us, it’s not simple at all. If we have a sore throat or twist an ankle, we know who to see and how to get our treatment covered. If we have depression or need help overcoming an addiction, finding a provider and getting coverage can be confusing. It shouldn’t be this way. By law, it should be as simple to see a therapist for anxiety as it is to see a doctor for the flu.
Is therapy coverage required by law?
Congress passed the Mental Health Parity and Addiction Equity Act in 2008 to make mental health and addiction treatment easier for people to obtain. The act does not require every insurance company to provide mental health benefits. But it does prohibit insurance companies from making mental health coverage more expensive or harder to get than physical health coverage.
Under the law, insurance companies that choose to offer mental health benefits must provide coverage that is equal to their physical health coverage. Companies must set copays, deductibles, and visit limits for mental and physical health care at the same levels. So, if your insurance company charges a $30 copay for a visit to your cardiologist, they can’t charge a $60 copay for a visit to your therapist.
Even with the law in place, though, it’s still more challenging and costly to get help for mental health needs than for physical health needs. Recent reports from The National Institute of Mental Health show that although 1 in 5 Americans have a mental illness, only about half receive treatment. For those who do seek treatment, some insurance company practices are still making it difficult to find and afford care.
What is the Mental Health Parity Rule?
The recent Mental Health Parity Rule is meant to change that. The rule, announced by the White House and the U.S. Department of Health and Human Services on September 9, has three main goals:
- It expands the number of insurance companies that are required to provide mental health benefits and physical health benefits at the same level
- It prohibits insurance companies from using subtle ways to make getting mental health care more expensive or restrictive than getting physical care
- It requires insurance companies to analyze their provider networks, prior authorization policies, and out-of-network payment rates to make sure they comply with the 2008 law
What Does the Mental Health Parity Rule Mean for Me?
If your insurance company offers mental health and addiction treatment benefits, the coverage must be the same as (or very similar to) what they offer for physical health. This means your insurance company must:
- Use the same standards for deciding if mental health and physical health treatments are medically necessary
- Follow the same prior authorization rules when approving mental health and physical health treatments
- Use the same hospital admission criteria for mental and physical health
- Pay out-of-network mental health providers the same reimbursement rates as they pay out-of-network physical health providers
- Make sure that all their policies and practices treat mental health and physical health benefits equally
How Should Mental Health Parity Work in Real Life?
When I broke my arm recently, the copay for my physical therapy visits was $28. When my family member needed therapy to treat anxiety, the copay for those visits was also $28. Under Mental Health Parity, this is the way it should be. Our brains and bodies are part of one whole, and we all deserve uncomplicated and compassionate care for both.
Where Can I Get Help or More Information?
Watch this video for more information about parity laws and how they apply to you.
Visit this website for more information about accessing mental health benefits and how to file an appeal if you have been denied coverage.
The author, Michelle Macias, is a K-12 teacher in Tucson, Arizona and staff writer at Phoenix Therapists’ Hub. She frequently writes about mental health in schools.