Posted on April 1, 2015
Health insurance plans are falling short in coverage of mental health and substance abuse conditions according to a report issued today by the National Alliance on Mental Illness (NAMI), based on a survey of 2,720 consumers and an analysis of 84 insurance plans in 15 states.
A federal “parity” law enacted in 2008 requires mental health benefits in some employer-sponsored plans to be provided on the same terms as other medical care. Coverage was expanded under the Affordable Care Act (ACA) in 2010.
“Despite the law, discrimination still exists toward mental health and substance use conditions,” said NAMI Executive Director Mary Giliberti. “Progress is being made, but there is still a long road ahead. NAMI’s report identifies areas where insurance companies need to improve and greater scrutiny is needed.”
See the following:
The report findings include:
- A Lack of mental health providers is a serious problem in health insurance networks.
- Nearly a third of survey respondents reported insurance company denials of authorization for mental health and substance abuse care. For ACA plans, denials were nearly twice the rate for other medical care.
- Barriers exist for mental health medications. More than half of health plans analyzed for the report covered less than 50 percent of anti-psychotic medications.
- High out-of-pocket costs for prescription drugs appear to discourage people from participating in both mental health and other medical treatment.
- High co-pays, deductible and co-insurance rates create further barriers to treatment.
- There is a serious lack of information about mental health coverage to enable consumers to make informed decisions in choosing health plans.
The report is based on a “Coverage for Care” survey of 2,720 individuals with mental illness or their family members. Survey results were supplemented by an analysis of 84 health insurance plan drug formularies in 15 states conducted by Avalere Health.
The report makes four recommendations:
- Strong enforcement of the 2008 parity law is needed at both federal and state levels, including establishing easily accessible procedures for filing complaints.
- Insurance companies should be required to publish the clinical criteria used to approve or deny mental health and medical-surgical care.
- Health plans should be required to publish accurate lists of providers included in their networks and to update them regularly.
- The U.S. Department of Health & Human Services should require all health plans to provide clear understandable, yet detailed information about benefits and to make this information easily accessible. HHS should develop tools to help consumers compare plans prior to enrollment. Congress and the Executive Branch must work together to decrease out-of-pocket costs under the ACA for low-income consumers.
About NAMI
NAMI is the nation's largest grassroots mental health organization dedicated to improving the lives of individuals and families affected by mental illness.
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