Mental health is just as important as physical health when it comes to our well-being.
According to the National Alliance on Mental Illness, nearly one in 25 adults experiences a serious mental illness that interferes with major life activities each year. Unfortunately, insurers haven’t always seen it that way. In the past, many health insurance companies provided better coverage for physical illness than they did for mental health disorders.
A law went in 2008, the Paul Wellstone and Pete Domenici Mental Health Parity and Enslavement Equity Act, which is otherwise called the mental health parity law or government parity law; requires the inclusion of services for mental health, behavioral health, and substance use disorders to be tantamount to physical health inclusion. However numerous individuals despite everything aren’t mindful that the law exists or how it influences them. In fact, a 2014 APA survey found that more than 90 percent of Americans were new to the mental health parity law.
This is a guide meant to help you learn what you need to know concerning mental health coverage under the mental health parity law and is therapy covered by insurance.
What to Know About the Law?
The government parity law requires insurance organizations to treat mental and behavioral health and substance use disorder coverage as equivalent to (or better than) medical/surgical coverage. That implies that safety net providers must treat financial requirements equally. For instance, an insurance organization can\’t charge a $40 copay for office visits to a mental health expert, such as a psychologist in the event that it just charges a $20 copay for generally medical/surgical office visits. The parity law additionally covers non-monetary treatment limits. For example, confines on the number of mental health visits permitted in a year were once normal. The law has basically dispensed with such yearly cutoff points. In any case, it doesn’t deny the insurance organization from actualizing limits identified with “medical necessity.”
What Health Plans Does the Parity Law Affect?
The federal parity law generally applies to the following types of health insurance:
- Employer-sponsored health coverage, for companies with 50 or more employees.
- Coverage purchased through health insurance exchanges that were created under the health care reform law also known as the Affordable Care Act or commonly “Obamacare.”
- Children’s Health Insurance Program (CHIP).
- Most Medicaid programs vary from program to program. Contact your state Medicaid director to know if the federal parity law applies to your Medicaid program.
Some other government plans and programs remain exempt from the parity law. Medicare, unlike Medicaid, for instance, is not subject to the federal parity law. And some state government employee plans, including ones that cover teachers and employees of state universities, may opt-out of the parity requirements.
How Would I Know If My Health Insurance Plan Provides Mental Health Coverage?
Check your depiction of plan benefits — it ought to include information on the behavioral health services or inclusion for mental health and substance use disorders. On the off chance that you despite everything aren’t certain, ask your Human Resources agent or contact your insurance organization straightforwardly. You can also click here to get more details on whether you have to pay for a mental health therapist on your insurance plan.
My Insurance Plan Doesn’t Have Mental Health Benefits. Is This a Violation of the Parity Law?
The parity law does not require insurers to provide mental health benefits — rather, the law states that if mental health benefits are offered, they can’t have more restrictive requirements than those that apply to physical health benefits. Fortunately, the vast majority of large group plans already provided mental health benefits before the parity law took effect. In addition, the Affordable Care Act requires that plans offered through the health insurance exchanges cover services for mental health and substance use disorders.
According to HealthCare.gov, these plans must cover:
- Behavioral treatments, such as psychotherapy and counseling
- Inpatient services for mental and behavioral health issues
- The treatment of substance use disorders
Are All Mental Health Diagnoses Covered by The Parity Law?
Unlike some state parity laws, the federal parity law applies to all mental health and substance use disorder diagnoses covered by a health plan. However, a health plan is allowed to specifically exclude certain diagnoses — whether those diagnoses are considered to be in the physical/medical realm or behavioral/mental health. Any exclusions should be made clear to you in your plan’s description of mental health benefits. If you are uncertain, ask your insurance company.
Who should I Speak to If I Think My Insurance Company Is Violating the Parity Law?
If you have concerns that your plan isn’t complying with the parity law, ask your human resources department for a summary of benefits to better understand your coverage, or contact your insurance company directly. Your human resource department can provide you with information about your coverage and may be able to put you in touch with a health care advocate who can assist in making an appeal.