Equalizing coverage for mental health and physical health

[Guest djodavis]

I am trying to find out what why so many companies do not have equalizing coverage for mental health and physical health. Any input would be greatly appreciated. Also if you would like to share what your company offers for both it would be great. At The Mental Health Association in Texas we have comprised a list of honor roll companies that do have equalization. If you are one of these companies, we would like to recognize you.

Thanks Deena

[leevena]

I have not heard of the term "physical health", so I am assuming that the question is asking why MH coverage is usually limited versus other types of expenses. If my assumption is true, then I voted no to your poll.

Let me start by saying that I fully recognize that MH should be a covered expense and that they do contribute to many physical conditions. However, unlike physical conditions, MH is much more difficult to diagnosis, treat, and then show a final outcome, such as a cure. The end result is that if treated the same as other physical conditions, the costs for these types of expenses could become very significant. The impact on rates could become dramatic.

Just my thougts and opinions. Good luck with your poll.

[Guest rsupergirl]

I intend to ask that question at our next renewal. Our health plan, which is very rich overall, pays $25 for "Mental and Nervous Disorder" treatments. I think it is outrageous to minimize the importance of mental health by offering such a small benefit. So many people could benefit from a little psychotherapy but find the cost is prohibitive. It's a shame.

[WDIK]

There are certainly some compelling arguments on both sides of this issue.

On the one hand, it doesn't seem fair to provide benefits for my hearing-impaired grandmother WDYS and ignore the mental health needs of my depressed nephew WDIM.

On the other hand, as leevena points out, mental health diagnoses are general more challenging than identifying physical maladies. For instance, is my brother WDIC's apathy a symptom of a serious mental illness or does he just have a grim outlook on life? What about my uncle WDYK? Does he put down other people because of some type of neurosis, or is he just arrogant?

In my opinion, it would be better to be somewhat cautious in providing sweeping mental health benefits, but as understanding of the human brain improves, appropriate guidelines could be adopted. Such an approach would not give additional fodder for my nit-picking cousin WWTT.

[Guest djodavis]

I intend to ask that question at our next renewal. Our health plan, which is very rich overall, pays $25 for "Mental and Nervous Disorder" treatments. I think it is outrageous to minimize the importance of mental health by offering such a small benefit. So many people could benefit from a little psychotherapy but find the cost is prohibitive. It's a shame.

I would love to know...in what state do you work?

[Guest rsupergirl]

I'm in California.

[leevena]

Would you mind tellling us what type of coverage you have, such as name of carrier, product name that are covered under, and whether you are a small group (under 50). THanks.

[jmor99]

I'll give you 2 examples of why i voted "no":

Parents are having difficulty with little Johnny. One of the parents has family coverage with a company that has no nervous and mental limits. They take little johnny to the local psychiatric hospital where he is checked in for 6 weeks for "evaluation". The hospital "delays" billings to the insurance carrier (the company is self insured), so the claims don't start hitting the books until it's "too late". By the time the bills are all in, over $70,000 has hit the company's paid claims listing. Rest assured I had no trouble convincing the employer to put in Nervous and Mental limits immediately.

I'm sitting in a theatre watching a movie. I can't help but overhear the conversation of 2 ladies in front of me. They're both talking about the difficulties they're having with their children and one of them advises the other to "take a vacation" by checking little Janie in at the local psychiatric clinic "for a week or two", because "your insurance will pay for it".

Might as well throw in one more: Wherever I have seen not-limited mental health benefits, I have seen exceedingly high utilization. It seems that people like to spend time with their mental health counselor as much or more than they do family members AS LONG AS SOMEBODY ELSE IS PAYING FOR IT. I know of one case that went on (3 visits a week) for over 10 years, and that person was no more neurotic or whatever than you or I. But somebody else was paying for it.

Furthermore, I have seen psychiatric clinics and hospitals perform miraculous cures which always seem to coincide with the moment that Larry Lunchpail's company paid benefits run out. Seems no one has figured out how to cure these folks BEFORE their benefits run out.

So you wonder why health plans have nervous and mental limits? Because a greedy few ruin it for the rest.

[Guest djodavis]

Would you mind tellling us what type of coverage you have, such as name of carrier, product name that are covered under, and whether you are a small group (under 50). THanks.

I actually work for The Mental Health Association in Texas and I am trying to get companies to voluntarily implement equal coverage.

[Guest djodavis]

I'll give you 2 examples of why i voted "no":

Parents are having difficulty with little Johnny. One of the parents has family coverage with a company that has no nervous and mental limits. They take little johnny to the local psychiatric hospital where he is checked in for 6 weeks for "evaluation". The hospital "delays" billings to the insurance carrier (the company is self insured), so the claims don't start hitting the books until it's "too late". By the time the bills are all in, over $70,000 has hit the company's paid claims listing. Rest assured I had no trouble convincing the employer to put in Nervous and Mental limits immediately.

I'm sitting in a theatre watching a movie. I can't help but overhear the conversation of 2 ladies in front of me. They're both talking about the difficulties they're having with their children and one of them advises the other to "take a vacation" by checking little Janie in at the local psychiatric clinic "for a week or two", because "your insurance will pay for it".

Might as well throw in one more: Wherever I have seen not-limited mental health benefits, I have seen exceedingly high utilization. It seems that people like to spend time with their mental health counselor as much or more than they do family members AS LONG AS SOMEBODY ELSE IS PAYING FOR IT. I know of one case that went on (3 visits a week) for over 10 years, and that person was no more neurotic or whatever than you or I. But somebody else was paying for it.

Furthermore, I have seen psychiatric clinics and hospitals perform miraculous cures which always seem to coincide with the moment that Larry Lunchpail's company paid benefits run out. Seems no one has figured out how to cure these folks BEFORE their benefits run out.

So you wonder why health plans have nervous and mental limits? Because a greedy few ruin it for the rest.

Don't you think that most of those examples are on the extreme end?

[Mary C]

djodavis -

I, too, have seen the abuses cited by jmor99. For example, mom and stepdad want an extended vacation so put teen age daughter in a residential mental health facility for 6 weeks due to "incorribility" while they are out sailing the Mediterranean. Never mind that daughter is an honor student and active in her church youth group. Daughter, is mysteriously cured and released when they return from their trip. And to top it off, she bragged about it to co-workers and even suggested someone else try it!

or my own sister, who was traumatically widowed at an early age, sought counseling to help at that time. Its almost 10 years later, she's remarried and she still goes at least once a week for her "bereavement" counseling. Sometimes more often. She's admitted if her plan didn't pay, she'd quit going, but as long as it continues to pay, she continues to go.

These situations are not as extreme or uncommon as you may think. Because its a gray area as to what is acutely needed, what's custodial, and what's just to unload, its not as easy to design guidelines to control abuse as it is for physical health treatments. That's why there is and will probably continue to be limits for mental health treatment.

Just my humble opinion.

[leevena]

djodavis...I am not un-sympathetic to your cause. However, as I and the others have posted, it is very difficult to determine when the "end" of treatment has occured. Any kind of an open-ended or similar level of benefits would cause health insurance premiums to rise rather significantly. Being in the employee benefit field for 25 years, I can assure you that while the jmor examples may sound extreme, they are not unusual. As for an employer or carrier taking on a voluntary approach, it would cause adverse selection in the market, causing costs to increase.

My suggestion would be to work through the state agency that is responsible for benefit levels. You may not get much headway, but that is the route you should take. Individual carriers or employers will not work for you.

[E as in ERISA]

From a personal perspective, I think that the primary reason for purchasing insurance is to cover catastrophic events. An unexpected bill for major surgery and hospitalization after a car accident. I like high deductibles (with corresponding lower premiums). I like self-insuring smaller risks. I'd assume that there are more "physical health" issues that are catastrophic in nature.

[Lori Friedman]

It seems to me that the line between "mental health" and "physical health" has become very blurred and indistinct during recent decades. So many "mental" conditions have been linked to physical causes and can be treated with modern psychopharmacology.

[jmor99]

Since my initial post sounds so cynical, I'll add the following opinion. In my opinion, ALL health (good or bad)

comes from the mind. To treat the physical is to treat the symptom not the cause. The cause is in the mind.

Unfortunately, current mental health medicine has not found an efficient, economical way to deal with the cause that it professes to treat.

The cold hard facts of health insurance is that it is NOT jmor insurance, it is NOT djodavis insurance, etc. It is GROUP health insurance. Thus, it is designed to serve the greatest number of people at the most acceptable, livable price. As such, it will never serve all of the needs of each unique individual.

Figure out how to treat the mind efficiently, effectively and economically and you will put the rest of the medical profession out of business, at which point there will be plenty of money for mental health.