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Re: Mental Health Insurance parity...what can you do? gardenergirl

Posted by mair on July 6, 2004, at 18:06:32

In reply to Mental Health Insurance parity...what can you do?, posted by gardenergirl on July 2, 2004, at 20:53:17

Am I not mistaken that there is now some mandated parity, at least for employers of a certain size?

I quit therapy several years ago because I ran out of benefits. (I hit my lifetime cap) Sometime after that Congress passed a bill that I thought required parity, but it was of no use to me because my employer wasn't subject to the bill anyway. Fortunately, the state I live in passed its own parity legislation which offers no exemptions for smaller employers. Mental health care can still be heavily managed under some plans, but at least there is no cap on dollars spent, like there was before.

I know how important this is. My state's bill enabled me to go back into therapy and has enabled me to stay in therapy. Since I only partially respond to ADs, therapy is pretty important for my stability, and I get pretty panicked whenever I think I'm going to lose those benefits. My employer is a part of a larger group which has had enough negotiating clout to force the insurance company to make unmanaged care an option for its members, albeit a much more expensive option. My employer, mostly at my urging, has opted into the more expensive plan. So I'm ok for now, but I don't know how much longer I can convince my employer to do this. Insidiously (and probably deliberately), the plan that includes unmanaged mental health care, not only has far costlier premiums, but is actually worse in the co-pay requirements for services which are unrelated to mental health care. So I am not only disadvantaging my employer who picks up the cost of the premiums, but also each employee here whose co-pays are higher essentially because I need this plan. Also I worry that the association of which we are a part, can not continue to force the insurance company to make unmanaged care an option for every member.

It was interesting to me how the insurance company responded to the change in the law. Quite literally, for several years after the law changed, the statement of benefits all policy holders received continued to cite the old, outlawed caps, so if you were uninformed, you'd assume those limitations still applied to you. Also, when they started having to offer a choice, the printed material they sent around totally misrepresented the insurer's preferred managed option and if you didn't respond very quickly, you were defaulted into the managed care option. This happened to my employer. When I brought some of the misrepresentations to the attention of the insurer, they let us opt into the unmanaged plan immediately. I think I wasn't the first person who complained, because they put up absolutely no argument.

It's getting harder and harder to hold onto unmanaged care - our plan costs a few thousand dollars more than the managed variety, and I'm pretty sure I'm the only person here who benefits. I go through this continual range of emotions about it, ranging from guilt that I have it so better off than most of the people on this Board, guilt that I'm actually receiving more in benefits than I pay in premiums, guilt that my therapy progress is so interminably slow, and then also anger that I have to feel guilty. I've read some insurance industry stuff that claims that they don't want to write big checks for therapy because there is no evidence that therapy really works for people with chronic depression. Sometimes I think I'm the poster child for this theory. Of course, the insurance companies are talking about cures, and most of the rest of us are looking at long term maintenance.

I guess I need to get off my soapbox, but your post brought all of this to the fore for me.

Mair


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poster:mair thread:362407
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