Coverage for mental health care examined
By Matthew Whittle
Published in News on October 4, 2007 2:16 PM
With the stigmas surrounding mental illnesses continuing to lessen and more and more people seeking services, the state General Assembly took the large step this year of passing legislation to require insurance companies to improve their coverage of mental health care.
It's a step that many in the industry think will have mixed consequences.
"I think for the consumer, it's a good thing," said Ed Spence, authorized agent for BlueCross BlueShield of North Carolina with Ed Spence & Associates. "But it's going to make premiums higher."
Under the old rules, he explained that most BlueCross BlueShield insurance plans -- like others -- did cover mental health care. And often, he said, with the same co-pays as traditional health care.
The difference, however, was that for mental health care, the number of visits and the amount of money the insurance company would pay were limited.
Most plans allowed only 20 office visits and 30 days of in-patient/out-patient care per benefit period, as well as an $8,000 maximum pay-out per benefit period and $16,000 maximum lifetime pay-out.
"The inequity was in those caps," Spence said.
The new rules, though, only take those restrictions off of certain mental illnesses, treating them the same as physical ones.
Those are: bipolar disorder, major depressive disorder, obsessive compulsive disorder, paranoid and other psychotic disorder, schizoaffective disorder, schizophrenia, post-traumatic stress disorder, anorexia nervosa and bulimia.
"Those nine conditions are the ones that most often exceed the current benefit levels," Spence continued.
Other mental illnesses are still restricted to 30 combined in-patient and out-patient days per year and 30 office visits per year.
Chemical dependency treatments, however, are not required to be covered.
Still, the general consensus is that this bill is a large step forward for both consumers seeking help and providers looking to get paid.
"This will help not only the providers, but especially the clients," said Ken Jones, director of the local mental health management entity Eastpointe. "There are many people who have private pay who will not even seek mental health services because of the cost."
He is hopeful this bill will help change that.
"This is a big step in the right direction," he said.
Don Neal, clinical director of Waynesborough Family Clinic, agreed.
"(The cost and lack of coverage) was be a major hardship," he said. "It affected how people accessed the system and how much treatment they got."
And, he continued, it's a problem that had gotten worse over the years as the stigma of mental illness decreased, and more people accessed therapy and received medication.
"We've seen a lot more people over the years," Neal said.
But even he and Jones acknowledged that consumers with private insurance will likely end up paying more for that improved coverage.
The only question is how much.
"I don't have any data, but to me it seems logical that if you're going to take those limits away, the cost is going to increase. That's a significant dollar amount that used to be uncovered, that now will be covered, and if there's more coverage, there's going to be more premiums," Spence said. "But I would not expect there to be a huge increase in rates."