Parity for mental health coverage by insurance

July 22, 2008  |  General

Mental health services have for many years been the poor stepchildren in our healthcare system. Even families with “good” insurance often found to their dismay, when they needed it, that coverage of mental health problems was skimpy at best. Typically the total dollar coverage for all mental health services was capped at a fairly low number. Besides being unfair, even cruel, this practice makes little economic sense to our society; mental health problems are common, and untreated mental disorders lead to huge lost productivity.

We run into this problem from time to time in the PICU when we try to arrange care for children who need mental health care, such as depressed adolescents who attempt suicide (often by drug overdose) and end up in the PICU.

A major issue in getting parity in coverage is that the term “mental health problem” is quite broad, and specific disorders are sometimes difficult to define. The argument went that, if experts can’t agree on what something is, how can insurers be expected to pay for its treatment? The standard reference for defining mental health disorders is the Diagnostic and Statistical Manual of Mental Disorders (DSM), now in its 4th edition. The gamut of disorders this manual contains is wide, everything from severe schizophrenia to jet lag. Many insurers feared that granting parity to mental health claims would open a floodgate of trivial claims.

In fact, when mental health parity was allowed, this didn’t happen — the overwhelming majority of claims were for real, significant problems for which there is effective therapy. Once that became clear, insurers had no excuse any longer not to cover them. Congress recently passed a law requiring parity, but differences between House and Senate versions had the process stalled until a recent compromise.

This is a vital topic for many families. You can read two excellent discussions of the issue here and here.

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