Related to the conversation on the message board of yesterday's post, "No Joking About Crazy (Unless You're Crazy)," here's an interesting piece from the "Washington Post" on the disparity of coverage between health-care insurance benefits for those battling a mental disorder and those for other conditions. As you may have read in my post, "PayFirst CareLast," this is a topic that can launch me into the dangerous-anger zone. So let me just present some information ... this article for starters.
Written by Washington area Alicia Ault, the article is called "Equal Coverage For Mental Health? Many States Require Parity, and Congress May Order It Nationwide." To get to the "Washington Post" article, click here. I've posted it below in case the link doesn't work.
Q Why are my mental health benefits less generous than those that my insurance policy provides for other conditions?A When mental health coverage was first added to benefits packages a few decades ago, there was still a persistent belief that a condition like depression was not as real as heart disease or cancer. There also were few medications or other therapies that offered significant improvement. Many employers did not offer rich coverage because they assumed the government would eventually pay for treatment of serious mental illnesses such as schizophrenia or bipolar disease.
Beginning in the early 1990s, as therapies improved and awareness grew that mental conditions are genuine illnesses, patient and professional groups and some in Congress began to press for federal laws to require equal coverage of mental and physical health, meaning for example equivalent co-pays .
The initial effort was led by Sen. Pete Domenici (R-N.M.), who has continued to champion the cause. Currently, 42 states, including Maryland, require equal coverage. The federal employees' health benefit program also requires equal coverage. But 82 million Americans work for employers who self-insure, which means they are exempt from state parity laws, said Andrew Sperling, legislative affairs director for the National Alliance on Mental Illness. An additional 31 million are in other plans that don't have to offer equal coverage.
In September, the Senate unanimously passed the Mental Health Parity Act, which would require equal coverage. The proposal has won the backing of three committees in the House. The chances for passage this year are good, experts say. "It's a perfect storm in a good way," said Carolyn Robinowitz, president of the American Psychiatric Association.
If I use my mental health coverage to talk to a therapist or get medications from a psychiatrist, could my employer use this information to treat me differently at work or maybe even fire me?
Despite growing awareness that mental illnesses are scientifically documented and treatable diseases, fear of discrimination still makes some people wary of admitting they have depression, anxiety or other conditions. And that makes many apprehensive about seeking treatment -- much as people with cancer were fearful 20 or 30 years ago, Robinowitz said. Ron Honberg, policy and legal affairs director for NAMI, agrees that fear of discrimination is a barrier to care. "Whether it's perceived or real, it's something people worry about," he said.
Some laws aim to offer protection: privacy laws to prevent disclosure of personal medical information to unauthorized users; and the Americans with Disabilities Act, which bars discrimination for a perceived disability, which could include a mental illness.
But the world is not perfect, and some people may be wrongly exposed or fired, as can be the case with pregnancy or any medical condition.
I'm worried about the cost of treating my mental disorder. Do counselors or psychiatrists ever adjust their fees?
You may be able to get treatment for a reduced fee. Many larger companies offer an Employee Assistance Program, which often provides limited phone counseling for free.
Public mental health clinics in most localities also offer some care free or at a reduced rate, depending on income. Your state's mental health department help line can steer you to those clinics.
The American Psychological Association offers a consumer-oriented Web site ( http://www.apahelpcenter.org) as well as a referral service (800-964-2000); once connected with a local counselor, you can ask whether they operate on a sliding scale.
The American Psychiatric Association recommends asking practitioners if they will reduce fees, and offers other resources at http://www.healthyminds.org.
Georgetown University, George Washington University and Howard University offer mental health services, often at a reduced rate for lower-income individuals.
NAMI's Web site ( http://www.nami.org) also offers resources for patients. Robinowitz also suggests seeking help from support groups: Advocacy organizations for almost every disorder can be found in the phone book or on the Internet.
Add to Del.icio.us
Add to Technorati
Add to Digg
Add to Newsvine
Add to Facebook
Add to StumbleUpon
Subscribe
There are MANY practices of insurance companies/H>MOs that needed overhauling, mental health coverage among them! When I found out eleven years ago that my husband had been/was being unfaithful, I discovered first-hand how discriminatory they can be. At the insistence of my older sister who is a registered nurse of thirty years standing, I went to my OBGYN be tested for any and all possible sexually transmitted diseases. Also at her recommendation, I had the test for HIV done at the public Health Department where my insurance company would neither have to pay nor be aware of the test because my sis told me my insurance co. would "flag" my records as risky simply because I was evidently living a lifestyle that put me in fear of contracting that deadly virus and that would compromise my standing with them!! It was a most humiliating experience; I'd never felt quite so "dirty" in my life! Fortunately for me, all of the results were negative, so I didn't have to endure any further humiliation either at my doc's office or the health department, but it made me much more cognizant of the underhandedness of the insurance industry in terms of certain kinds of tests/treatments. I also discovered in 2004 when I was filing my disability claim with social security as was required by my independent long-term disability ins. co that mental illnesses are often flagged by THOSE beaurocrats as well! In spite of my psychiatrist's written verification that my illnesses made me equally unable to work as my newly-acquired paralysis and frontal lobe brain damage, I had to jump thrugh many hoops before I( was finally approved by "my" Social Security case manager. Keep in mind that I had worked for thirty plus years paying INTO the system without them being concerned as to my mental state; it was an entirely different ball game when it came to being "certified" as disabled and thereby eligible! Health care in our country is,IMHO, in terrible shape. (talk about mental illness.. the entire system is in need of some serious theraphy!) I'm going to exercise my right/responsibility as a registered voter to contact my senator and state my position on the Mental health Act and encourage everyone else to do likewise. While my paralysis is indeed limiting and difficult, my mental/spiritual/emotional issues are even MORE crippling, and more than deserving of equal consideration/rexvompensation!
Well now this is interesting. Seems My family will get to find out first hand whether or not his insurance will cover my older brother's suicide attempt. His wife is divorceing him ,probably in part due to his struggles with alcoholism, and he decided to take some 30 odd tranquilizers. He changed his mind and called 911 and off to the hospital he went. My sister-in-law,in all her compassion, tells my Mom he just did it for attention. Guess I missed the bus on that one. Here I thought he'd opt to off her instead. It's true sometimes suicide is anger turned inward. His co-AA friends suggested he check himself into rehab ASAP. Good advice! I don't know what to feel at this point...except I get it!
What a sore spot? First you have to deal with your own family & friends trying to understand what your dealing with when you have a mental illness, then you have to fight your way the insurance co. h*ll, and then still get denied. I was denied short-term disability for my depression twice. It wasn't until I spent 3 weeks in an outpatient program at the mental health facility that I was paid. Moreover, that was only for the time they considered me "hospitalized". I had worked for the same LARGE & well-known company for 23 years. For 20 years, I was an exemplary employee (at least according to my bi-annual reviews with bosses.) I figure I must have been doing a good job to work all those years & only worked for two different people for the majority of that time. I had been given the highest review ratings and salary raises during all those years. Then, just when it seemed as though I had everything to live for, I was overcome with severe depression. People don't just go from being a fully functioning person to not being able to pull your head out from under the covers. You would think that would be a clue to people that knows you! Sorry, folks, I digress. The "company" that I worked for had excellent benefits for medical & mental health, however the plan was administered by a third party & the company had set up the contract so that the third party had the final say on granting or denying benefits. I found that no matter how much information was sent to them by my doctors, it all had to go past the case mgr before it went to the case supervisor and then to the nurse/dr. for review, it was going to be denied. They also had something like 90 days to respond. You have to be planning to commit suicide before anybody does anything. So much of what we all suffer could be caught much earlier if there weren’t such a negative stigma of "mental illness".
I've obviously gotten on my soapbox this time. Let me wrap this up by saying that after 23 years I resigned from my position. I had fallen from the top to the... well, what felt like the pathetic to me.
Since I've found BB, I have become so much stronger just by having a community that understands what I face everyday. Here on BB, I'm not being judged. (That's another thank you for Therese!) I would very much like to find someway to help our community of "crazy people". (Thanks for etiquette reminder on that one, Therese. It cracked me up! lol) I can say "crazy people" because I am one of them! Right now, darn proud of it!
I would sincerely appreciate any suggestions for ways to be more involved. For mental health coverage, disparity in the workplace or any other issues that we, as a community, face.
I had a good experience with an HMO my wife and I were a member of. Bipolar was pre-existing, but they covered everything. The only drawback might be that I didn't see the pdoc very often - they saved money by setting an appointment once every 6 months. But they had no problem accomodating me for the meds I preferred - even when that made me an unprofitable account for them. It was just my own small business policy also - with just two members, which is usually an area where health insurance companies send you the dear john letter and drop you. My copays were very small.
The bill was $450 a month and I had no choice but to cut it out though. I am still uninsured and have been for a few years now. So I pay 100 percent out of pocket for my pdoc and anti depressant.
I spoke about the politics earlier ...
On the substance:
I was a member of an HMO in the Annapolis area when I was first diagnosed in 1997. (Probably the forerunner to Therese's "CareLast"!!) Sad to say, they were completely incompetent. My psychiatrist and therapist (separate, of course) were kind, sweet women; their empathy fooled me into thinking, at a point early in my diagnosis when I didn't have the self-education, that they knew what the heck they were doing.
(Or maybe they did know, and were trying to keep my care costs down ... yecch.)
I was medicated solely for unipolar depression, which meant the SSRI's (and my body rejected several of them) were slowly but surely pushing me toward mania -- which finally happened (also spurred, of course, by the stress of my divorce) in early 2000.
Any first-year medical student, or even an actor on House or Grey's Anatomy, could have figured out in retrospect from my symptoms that I had bipolar disorder. When I went from full mania to full depression to full hospitalization, I asked my (former, to say the least) psychiatrist why hadn't diagnosed me with BD earlier. Her response: "Well, we did explore the possibility ..." Ugh. I should have sued for malpractice.
My current "psychiatrist" (actually not an M.D.; she is an APRN with prescription privileges) is the recognized expert in central New Jersey on bipolar disorder -- numerous papers, presentations, etc. She does not take insurance, period. Her fee is reasonable enough (except I wish I could afford to see her more than once a month), but it's well worth it to know she is "unbought."
(Plus, I've seen her on and off now since that last breakdown 7-1/2 years ago -- she knows all the ups and downs of my history since, and I've kept out of further hospitalizations. More peace of mind.)
Post a Comment
By submitting these comments, I agree to the beliefnet.com terms of service, rules of conduct and privacy policy (the "agreements"). I understand and agree that any content I post is licensed to beliefnet.com and may be used by beliefnet.com in accordance with the agreements.