Whenever there are new laws and regulations made y the government, there’s a company out there trying to find a loophole. Unfortunately, when it comes to coverage, millions of Americans are being denied or delaying vital treatment for addiction and mental illness because a few companies created their own loopholes.
A recent article in the New York Times detailed how the Obama administration plans to hold insurance companies accountable for violating mental health parity laws. While almost all health insurance companies provide coverage for mental illness and addiction, there’s often still a lot of red tape for treatment options. If the current administration has any say, insurers will not be left to their own devices. The White House task force is part of the Obama administration’s effort to tackle the opioid epidemic that’s raging nationwide and get people much-needed mental health care and addiction treatment.
The task force, so far, has recommended regular audits of insurers to make guarantee that plans follow mental health parity laws. They are also warning insurers to eliminate red tape for those seeking treatment. Illegal prior authorizations are a common practice by some insurers that leaves many of their customers frustrated. Insurers aren’t supposed to make it any more difficult to see a mental healthcare provider than any other specialist.
The task force noted flagrant violations in some insurance policies. Some insurers have illegally charged higher copays for mental health visits. Other providers have unfairly limited the number of treatment visits a person can receive. Most health insurance companies, for example, pay for at least ten visits to a physical therapist. But when it comes to mental health appointments, some insurers have limited therapy visits to just half that amount.
Some insurers also make unreasonable demands of mental health and treatment providers. The task force wants to quash the idea that the insurance companies can micromanage therapy or psychiatry by demanding specific results such as the very subjective “measurable and substantial improvement” for mental health treatment within 90 days.
One barrier to mental health and addiction treatment, however, is not left up to the insurer. As more people get help for their problems, fewer beds become available at inpatient facilities. Social workers, therapists, and psychiatrists participating in Obamacare insurance program often cite long wait times. An initial consultation or evaluation can take a month for new patients to set up. This can cause nervous patients to back out of appointments.
It’s unclear what the next Presidential administration will require from insurance companies in the next few years. (After all, one of the most-mentioned goals in the first 100 days of Mr. Trump’s transition is said to focus on repealing Obamacare.) Mental health parity laws have been in practice since the mid-1990’s. Insurers found loopholes and ways to exploit and void coverage, so President Obama strengthened the laws when he got Obamacare passed. Insurers have still been looking for sneaky ways to prevent covering these services. Many have chosen to refuse to cover out-of-network providers, creating a backlog of suffering people needing care.
Whether the laws are fairly enforced or hold insurers accountable is dependent on a strong plan by the government. Enforcement of these laws can help save lives and help addicts get. Let’s hope the task force’s plan isn’t axed based on politics. Treatment saves lives, and addiction has no political leaning.