Mental Health and Insurance

In My Humble Opinion
1

I figure, let’s combine the onerous government intrusion upon healthcare with a swift reaction brought upon by the Connecticut school shooting and we can watch all of the Conservatives’ heads explode at once… :stuck_out_tongue:

Seriously, I have a personal anecdote and I want to see how prevalent it is and see if there is something that should be done about it.

My stepson has massive behavioral and mental health issues issues. He has been in intensive therapy since he started kindergarten (he is in the 5th grade now) and has had a slew of medication at any given time - right now he has four prescriptions. He has been diagnosed with Asperger’s Syndrome and ADHD while other things such as ODD have been bandied about.

And in light of his current poor behavior with regard to respecting adults, making threats at school (after we explained this isn’t the best time to do such things, of course he does it and gets suspended from school for the remainder of the week) and the exasperation of his mom and myself, he is being ramped up into something called Family First - intensive therapy three times a week.

For most of this time, my stepson was on Chip or Medicaid, depending on whether my wife was working and how much she was making when she was. My previous employer paid livable wages but only paid for health benefits for me and did not offer insurance for the family and it was cost-prohibitive (think of COBRA-type rates) to add them however since my income did not count for my stepson and my wife either had poorly-paying full-time jobs, part-time income or even bouts of no income, he qualified for those things.

About 2 1/2 years ago I got a new job in a new field. This position paid more than twice as much as my previous occupation and more importantly offered benefits for family members at a reasonable rate. So even though my stepson would still qualify for assistance, I felt a moral obligation to add him to my policy and set about doing that.

I do not know how the insurance plan we have compares to other plans out there, but I will say that it is with a major company everyone knows (Cigna). I called them and went about trying to add him to my policy.

When I did, I asked about the mental health benefits. I was shocked when I was told there isn’t much to speak of. My son needs weekly therapy at the very least. However my insurance only offers six free therapy visits annually - basically it just covers crisis care and nothing more.

After that? We pay out of pocket. The costs could easily be many thousands of dollars a year and even more. Plus I have no idea whether they would have allowed the week he spent in in-patient care when he broke down a door at home. Of even if they would cover the Family First expansive therapy. Or whether we’d have to fight them when they prescribe an expensive drug to try.

So I thanked them for the information and told them we wouldn’t be adding him to the policy and he is staying on Medicaid. It’s the only decision that made sense.

But if I was his biological father, none of this would be possible and I would have to choose between a ton of out-of-pocket expenses for his healthcare - some of which would really be problematic to pay - or not being able to give a messed up kid the care he needs.

With Medicaid, we have never paid a penny for anything. Even when he was on Chip, we paid only $25 a year and no more out of pocket expenses. There isn’t even a co-pay for his medication.

The second biggest issue aside from gun control that seems to have come from the Connecticut shooting is concerns over how we deal with mental health issues in this country. It seems that a really good way to start would be to require that insurance companies offer comprehensive coverage for mental health issues.

Is this a problem in general or is my experience unique? If it is a problem, would requiring insurance companies to offer mental healthcare be a good start, or would that just be cost-prohibitive?

2

Part of the Economic Stabilization Act of 2008 included a provision that IF insurance covers mental health/substance abuse care, that it must cover it the same as any other physiological disorder.

That said, it does not require insurance to offer coverage at all for MH/SA.

Sounds to me like your plan does not cover MH at all, but your employer has an EAP (employee assistance program) in place which is separate of the health plan. It’s probably administered by the same company though.

One thing to keep in mind is that in a large number of cases with employer sponsored coverage, it’s the employer and not the insurance company who makes this decision.

It’s likely your employer decided that they didn’t want or need their health plan to include MH/SA coverage.

Actuarially speaking, I don’t know what the cost difference is between offering and not offering MH/SA coverage. I’ve read some things that claim there is an ROI on covering it because MH issues can lead to physiological problems. But I don’t know if these claims are valid.

In my area/region, I would say it’s pretty rare for an employer plan to exclude MH/SA. I have yet to work with (I work for a health insurance company) an employer group that did so in the 18 years I’ve been in the industry. But I can only speak for employers in my area.

3

Your insurance policy does seem pretty draconian, I’ve probably looked at a thousand policies and not seen anything remotely like that, but yes you need to yell at your employer, not your insurance company. Unless it was a very small company that bought a boilerplate policy, your company decided what benefits they wanted or did not want for their employees, and if it’s self-insured like most larger companies are they can legally get by with a lot more. (as to the hospital stay, we don’t have your contract in front of us, you’ll need to look at it or call and find out, hospital benefits are often different from outpatient benefits. Also, some contracts will offer more therapy visits with a prior authrization. My company has a team of nurses that do nothing but help our subscribers navigate the system).

(I’m a conservative but I actually support health care reform, and the company I work for officially does too; working in the industry gives me a different perspective than what Fox news is spewing).

4

The CHIP system is definitely broken.

I work for the government (in a job that I truly love). My income is about $100 over the limit for PandaKid to be on CHIP. It would cost me about $550 a month to add her to my insurance at work. So … she’s uninsured. Just broke her wrist, too - Merry Christmas.

But if I were to leave MrPanda (SAHD) and her and take my income with me … she’d be covered. Way to encourage marriage, huh?

Mental health coverage seems to be abysmal from what I’ve gathered at work. My insurance company is halfway decent, I think it pays for 24 sessions which is fine if you’re a garden variety psych patient like me that only needs follow up like every 3 or 4 months so the doctor can cover their ass with the FDA. If I were really nuts, though, I’d be fucked fairly quickly.

5

This really is not a debate.

Between a general request for others’ views, (IMHO), or an actual request for specific assistance/recommendations, (MPSIMS), it currently looks more like the former, so there it goes.

6

I’ve known mental health coverage to be disgusting.

Hubster is retired US Army. CHAMPUS (now TriCare) probably has the best mental health coverage of damn near everyone. Anyplace I’d work, my coverage would have to be coordinated with his, and invariably, CHAMPUS would end up paying the lion’s share.

I’ve seen policies that say outpatient coverage is 50%…up to $40. The idea of an outpatient visit “only” costing $80 is in the same league as the Easter Bunny or the Tooth Fairy.

Typically, visits are limited to say, 20 per calendar year. If you’ve got a troubled kid, you’ll need more than one counseling visit every two weeks.

Inpatient coverage is just as dismal.

Substance Abuse can be limited to 30 days inpatient…one trip per LIFETIME.

But hey, a heart transplant? No worries, that’s covered!
~VOW

7

For VOW

As thatguyJeff said above, the law that went into effect approximately four years ago states that if an insurance covers mental illness, they have to cover it the same as other physical illnesses. That is part of the Economic Stabilization Act. Patrick Kennedy worked for a long time to get something like this passed. Somehow it got attached to bailout measures and was passed. You might try Googling the act or talking with the the person’s psychiatrist. It doesn’t, I don’t think, cover visits to psychologists. At first the assistants who answered questions at my insurance company were unaware of the change in the law. So I had to educate them. It’s certainly worth looking into. A Congressional Representative could probably supply information about that part of the law.

8

VOW, I did find one bit of information on the law that said that it does not apply to individual policies (as opposed to group policies) and it doesn’t apply to insurance contracts negotiated by employers with less than fifty employees.

9

To Zoe:

Thanks so much for the info. My son, who needed the care, is now grown and on his own. But it was tough going for many years. And as I said, we ALSO had CHAMPUS/TriCare, which meant he got the care he needed, with much less out-of-pocket than most other insurance coverage!

Handling dual coverage is SO MUCH fun! (NOT) But that’s a thread unto itself!

When I was in the thick of the insurance blather, I did feel such pity for people who had the typical absymal coverage at that time.
~VOW