You might not always be able to spot the symptoms of a brain illness, but it’s more common than you’d guess. In any given year, one in five American adults struggles with conditions like depression, anxiety, and substance abuse, according to the National Alliance of Mental Illness. All those behavioral health conditions are considered brain illnesses.
But fewer than half of these affected Americans will receive treatment that can make them better—or even save their lives. One big reason: out-of-pocket costs. Federal law requires insurance companies to cover mental health conditions in the same way as medical care for, say, arthritis, cancer, and diabetes. Unfortunately, this isn’t always the case.
This isn’t a new issue. Behavioral health conditions weren’t adequately covered in many traditional health insurance plans, until the Mental Health Parity and Addiction Equity Act (MHPAEA)—otherwise known as the Federal Parity Law—was signed in 2008. It was subsequently strengthened as part of the Affordable Care Act. The law requires most insurance plans pay for mental health, eating disorders, and addiction care, the same way they cover physical health problems.
This means if you have a $10 copay to see your doctor for the flu, you should have a $10 copay to see your doctor for depression, anxiety, or addiction. Sounds good—in theory. But in practice? Not so much.
According to a 2017 report commissioned by the Mental Health Treatment and Research Institute, behavioral health providers, such as psychiatrists and psychologists, were paid 21% less than doctors who treat physical health, like family or internal medicine doctors.
This pay disparity means fewer behavioral health providers participate in insurance networks—and that means patients often must go to out-of-network doctors for behavioral health care.
This means, says Dr. Rupali Chadha, MD, a psychiatrist in Norwalk, California, “if your medical coverage isn’t great, your mental health coverage isn’t great either.”
The result: higher copayments—and higher costs—for those coping with mental health issues. Forced out of their network, patients must pay their doctors in cash, at rates that start at about $100 a visit.
And that’s not the only problem people face when they’re seeking mental health care.
“Insurance companies can put up lots of obstacles,” says Roland Lamy, executive director of the New Hampshire Behavioral Health Association. “They use the traditional insurance tactics, like restricting networks, rejecting authorization requests, limiting services that are covered, and denying claims. It’s death by a thousand papercuts.”
Some people just don’t have the money to pay out of pocket, so they skip treatment altogether, which often has tragic results: those who don’t get the care they need often die of overdose or suicide. That makes parity a matter of life and death.
Here’s a guide to the Parity Act—and tips to help you navigate the system—so you can get the care that the law entitles you to.
Knowledge is power, so learn everything you can about parity for behavioral health conditions. Start with these four facts.
Despite the law, there are several situations in which insurance companies may make it difficult to have your behavioral health regimen covered. Here are some ways that health plans affect the cost of your treatment:
When it comes to behavioral health, many insurance companies and BHOs tend to turn you down.
“Become educated,” advises Carneal. “Get familiar with your insurance policy and all the related plan documents to understand what’s covered and what’s not. And learn the process for filing an appeal. There are lots of moving parts.”
Golden rule: Don’t take no for an answer. “It’s very difficult for patients and their families—and their providers—to track why a recommended treatment isn’t being covered,” says Carneal. Parity law could be on your side.
The appeals process can be daunting—and time-consuming. “Behavioral illness isn’t like other illnesses,” says Dr. Chadha. “With cancer, you may be weak but you can still make a phone call. But when you have a behavioral illness, you’re not only physically exhausted, [but] you’ve got a cloud of hopelessness over you.”
Here are some helpful tips to open up the conversation with your health plan: