It appears that insurance companies are still not dispensing the same type of care for addictions and mental health as they may do for those with cancer or diabetes. This is frustrating as the insurance companies that do provide mental health and substance abuse coverage to their clients, are supposed to provide it in the same manner as any other medical coverage.
About the MHPAEA Law
This is due to the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) that was signed into law on October 3, 2008, and its effective date was January 1, 2010.
It reads: “The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) requires group health plans and health insurance issuers to ensure that financial requirements (such as co-pays, deductibles) and treatment limitations (such as visit limits) applicable to mental health or substance use disorder (MH/SUD) benefits are no more restrictive than the predominant requirements or limitations applied to substantially all medical/surgical benefits [1].”
Battling The Insurance Companies
Recently, a situation occurred where Seabrook House, an addiction treatment center, chose to cut ties with Aetna, one of the largest insurance providers in the country. The relationship between Seabrook House and Aetna had surpassed 20 years. Seabrook House ended the relationship because they believed that Aetna was not following the guidelines of the MHPAEA.
The president of Seabrook House, Ed Diehl, stated:
“We have been on the front lines in the war on drugs and we have found that often the hardest battle we fight each day is with the insurance companies that are in the business of denying the coverage its members are entitled to receive [2].”
With this being the toughest battle that a treatment center is fighting, is it no wonder that healthcare, insurance and most things medical are receiving such a bad image? So many other addiction centers and other healthcare professionals are fighting the same battles that are being fought by Seabrook House.
Healthcare Costs Rising
Can one really be surprised that medical care is too expensive? It is fraught with countless denials by the insurance companies and mounds of paperwork. How can a treatment center continue to accept insurance coverage if the insurance companies persist in denying claims and forcing the treatment centers to file appeal after appeal on claims that are legitimate?
How can that same treatment center help those addicted to klonopin, hydrocodone, meth or heroin; the ones that truly need help but have to rely on their insurance coverage? A treatment center cannot continue to function if they are constantly losing money.
The End Result
The sad reality is if insurance companies continue to deny legitimate mental health and/or addiction claims, then those who truly need help but cannot afford it will be the ones who suffer.
Resources:
[1] http://www.dol.gov/ebsa/newsroom/fsmhpaea.html
[2] http://www.heraldonline.com/2013/07/10/5011427/seabrook-house-ends-20-plus-year.html