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Mental Health and Insurance: The Climb For Coverage

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There has been controversy among patients and insurers about mental health care in the United States. Insurance providers are putting a lot of stress on their clients when it comes to what they’ll cover for their mental health, where coverage is provided, and for how long. This is a battle of understanding arbitrary legal jargon and discovering loopholes in the Mental Health Parity Act (MHPA).

 

The MHPA was signed into the state legislation law on Sept. 26, 1996. The act was meant to give mental health benefits to patients through their health insurance issuer, offering the same amount of coverage as they would through any medical or surgical benefits provided. Insurance providers, however, have attempted to manipulate this law over the years for their own gain.

MHPA Timeline and a Counselor’s Input

 

Licensed Clinical Professional Counselor (LCPC), Maralee Hubble, has over 25 years of experience in the behavioral health field, and since starting her private practice, says in an exclusive interview that insurance companies have been finding loopholes to avoid having to provide coverage for mental health patients. She is now barely starting to see the mental health benefits becoming enforced. “Insurance companies have so much power,” said Hubble. “Mental health patients are passive and feel the only fight worth fighting is the battle they face with their illness.”

 

In 2008 the Mental Health Parity and Addiction Equity Act was signed by George W. Bush but was still not fully enforced until the Newtown Massacre in 2012 put pressure on the government to provide fair coverage for mental health and substance abuse.

 

In 2014, Obama’s Affordable Care Act finally started showing signs of enforcing MHPA, indicating coverage for mental health and substance abuse as long as the mental health diagnosis is “medically necessary,” but does not affect those with Medicare or Medicaid — even though the link between mental illness and poverty has been clarified for decades.

 

Hubble explains how she is happy for her newly covered patients, but bothered by the term “medically necessary” because some of her patients are required to have a prescription for their particular mental illness in order to qualify for coverage. “I’ll get more clients who can afford more sessions with me now,” said Hubble, “but just because they’re upset about something doesn’t mean they need anti-depressants. Raw counseling should be the initial remedy.”

Hubble says she has had patients who will pick up their prescriptions every month but refuse to take any of the medications due to the side effects. They keep their coverage however, so they can continue to pursue counseling at an affordable rate.

 

She especially believes that substance abuse isn’t curable from any pharmaceutical medications — and that it causes the abuser to rely and become dependent on the medication. She finds the medicinal treatments counterproductive, claiming it is a drug for a drug. As an advocate and counselor for psychotherapy, she feels that her patients should be receiving hands-on counseling in lieu of the medication.

Veteran and Non-Veteran Mental Health Coverage

Despite progress, mental health care is not always consistently or sufficiently covered by health insurance. Mental health conditions are also on the rise. According to The Patriot Group:  

  • 18 percent of adults have a mental health condition. That’s over 43 million Americans.
  • Youth mental health is worsening. Rates of youth with severe depression increased from 5.9 percent in 2012 to 8.2 percent in 2015.
  • More Americans have access to services. Access to insurance and treatment increased, as healthcare reform has reduced the rates of uninsured adults. But most Americans still lack access to care. 56 percent of American adults with a mental illness do not receive treatment.
  • There is a serious mental health workforce shortage.

 

After seeing a large majority of active-duty military veterans returning and seeking mental health counseling, the United States has built a respectable infrastructure for veterans with or at risk of PTSD. However, according to Bradley University, because the conversation regarding PTSD has only recently touched upon how the disorder affects non-veterans, there are few outlets for assistance that civilians can take advantage of.

 

The Veterans Health Administration and Department of Defense have taken a progressive approach to ensure veterans and active service members have access to mental health treatment. This government initiative is not found with those who are non-veterans who suffer similar symptoms such as PTSD.

 

While steps are being taken to ensure better mental health coverage, mental health conditions are on the rise and many patients may feel like insurance companies are putting them as a less important side project. There are still gaps to bridge before mental health clients and insurance companies see eye to eye. Until then, it’s important for those seeking treatment to educate and protect themselves, because it will take a larger voice in order to keep insurance companies accountable in today’s world.

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