Monday, November 8, 2010

Health Insurance Companies Fight Back Against Mental Health Equality Law

Editors note: We need to keep an eye on this. This could be used as a template to repeal insurance coverage for autism.

In 2008, when comprehensive healthcare reform was only a theory in Democratic presidential primary debates, one bit of changes occurred. That year, Congress passed a bill that requires health insurance companies to treat physical and mental illness equally. This law was mostly spearheaded by Democrats, though mental health parity is nowhere near as much of a controversial issue as general healthcare reform has turned out to be.

Specifically, the law prevents discrimination against mental health and substance abuse patients by insurers. They can no longer be charged higher deductibles or co-payments of medications or hospitalizations than would be charged if they had a physical illness. For example, the insurer can no longer limit the number of reimbursed days a patient can remain in a hospital or in-patient treatment beyond the standard limit they have for other types of care. Nor can they limit the number of outpatient visits to a psychiatrist.

The health care industry has supported the law, and insurance companies support its intent. However, formal guidelines for enforcing the law were only released recently. Some fear that the Obama administration’s rules go too far.

While they agree with the goal of ending discrimination towards mental health care, insurers feel that the federal government regulating so-called “non-qualitative treatment limits” is an overstepping of its boundaries. Major health insurance plans believe that the intent of the bill is not to equalize provider reimbursement of services. As a result, interfering in how they manage care will have a negative impact, especially since the rules are so vague that they could potentially apply to any method used to manage benefits.

On the other hand, mental health advocates believe that doing so is necessary because of historically low reimbursement rates. Their view is that if insurers don’t pay competitive rates, they will attract few mental health services to their networks. Patients will therefore be forced to either travel long distances to receive services, go out-of-network for more expensive treatment, or forgo treatment altogether due to cost. In effect, that puts more of a burden on those with mental illness than people with physical illness–therefore violating the spirit of the law.

Another aspect of the rules disliked by Aetna, Blue Cross Blue Shield, and other large health insurance companies is the provision that mandates them to charge one combined deductible, as opposed to separate deductibles for medical and mental health. They predict that the requirement will actually make mental health care more expensive, but Obama believes that it is necessary to avoid inappropriate distinctions.

About the author: Yamileth Medina is an up and coming expert on Affordable Health Insurance and Healthcare Reform. She aims to help people realize that they can find a quality health insurance plan right now. Yamileth lives in Miami, FL.

Thursday, November 4, 2010

Expert Q&A: My child has autism

Posted October 29, 2010 at 9:13am by Elaine Saly

Question: My 16 year-old son has autism. He currently receives survivor benefits from Social Security. These will end when he's 18; however, his autism won't. Will health reform provide any services or support for our autistic children as they become adults?

Answer: Yes, your son and other young adults with autism will benefit from many provisions of the Affordable Care Act. The new law provides new protections for people with developmental disorders, ensures that mental health services are covered, and expands community-based supports for people with disabilities or chronic conditions who need long-term care.

Consumer protections: Currently, many people with developmental disorders face discrimination from private insurers based on their “pre-existing conditions.” Beginning in 2014, the new law will prohibit health insurers from denying coverage to any American because of a pre-existing condition, such as autism, and will stop insurers from excluding coverage of services for these conditions. These protections are already in effect for children under the age of 19. Starting in 2014, insurers will also be prohibited from charging people higher premiums because they have a pre-existing condition. In addition, the Affordable Care Act stops insurance companies from imposing lifetime or annual limits on the dollar amount of health benefits that they cover. The prohibition on lifetime dollar limits on coverage is in effect now, and the ban on annual limits will be phased in until the limits are completely prohibited in 2014. These new protections will ensure that people with developmental disorders have access to reliable and comprehensive health coverage.

Comprehensive benefits: Under the law, all new health insurance plans (sold on or after September 23, 2010) must cover certain preventive services, including autism screenings and developmental assessments for infants and young children, at no cost to consumers. Starting in 2014, plans sold through the new health insurance exchanges must cover mental health services, including behavioral health treatment, and they may not impose more restrictive coverage limits for these services than they do for physical health services.

Long-Term Services and Supports: People with developmental disorders or chronic health problems who require long-term services and supports will also benefit from the Affordable Care Act. The law will expand access to long-term care delivered in peoples’ homes and communities (instead of in institutional settings like nursing homes) by allowing states to increase the income eligibility levels for these programs. It also lets states tailor their home- and community-based service programs to meet the needs of certain populations, like children with autism or adults with traumatic brain injury. Additionally, the Affordable Care Act prohibits states from limiting the number of people who can get community-based services and supports and stops states from keeping people who need these services on waiting lists. The law also provides states with new federal funds to assist with the cost of personal care services for individuals with developmental and physical disabilities.

The Affordable Care Act is a huge step toward improving equality in access to health care for people with developmental disorders. As a result of the law, people with behavioral and mental health needs will finally be treated fairly by insurers and will be guaranteed access to affordable and comprehensive coverage, and those needing long-term services and supports will be able to live more independently.