The Mental Health Parity Law:
Making Mental Health and Substance Abuse Treatment more Affordable
Healthy Living – May 27, 2014
Dr. David Prescott – Eastern Maine Medical Center Behavioral Medicine
Most patients and healthcare providers now recognize that when it comes to our well-being, mental health is as important as physical health. Even though about 1 in 4 Americans have received counseling or some type of mental health treatment from a professional, most people are unaware of important laws concerning how health insurance plans must provide for mental health and substance abuse treatment.
The Mental Health Parity Law: In 1998, Congress enacted the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act, also known as “mental health parity.” This law requires health insurance plans cover mental health and substance abuse treatment with the same benefit as most other medical treatments and procedures. For example, insurance companies can no longer have a $40 copay for psychotherapy if the co-pay for most other medical services is $20. The law also mostly eliminates any type of cap on the number of mental health treatment visits allowed in a calendar year.
Making Mental Health Treatment More Affordable: All of the health insurance plans offered under the Affordable Care Act (also called “Obamacare”) are required to have parity for mental health treatment. Also, health insurance offered through large employers (50 or more employees) must have parity for mental health treatment.
If you are concerned about whether you or your family member can afford mental health or substance abuse treatment based on your health insurance, be sure to understand the following:
· Health Insurance Co-Pays: Co-Pays are the amount that patients usually pay out of pocket for each visit to a health professional, including a mental health professional.
· Number of covered sessions: For most health insurance plans, there is no limit on the number of counseling sessions you may attend, as long as the sessions meet the definition of medically necessary.
· Medications vs. psychotherapy: Most health insurance plans cover both psychotherapy and medications for mental health problems. Research suggests that for many mental health problems, both psychotherapy and medications are effective.
How Do I find a Mental Health Professional? Estimates are that as many as three in five people with a mental health or substance abuse problem receive no treatment. Finding and choosing a mental health professional presents a challenge for many people. The following tips may help:
1. Choose a licensed professional: Psychologists, social workers, psychiatrists, and licensed professional counselors receive licenses from the state in which they work. The state ensures that these professionals have received appropriate academic and clinical training.
2. Health Insurance Provider Networks: Many health insurance plans have a list of mental health professionals in your area who accept a given health insurance plan. You can usually get the list by calling your health insurance representative.
3. Referral from a primary care provider: Most primary care physicians know of reputable mental health professionals in their area.
4. State provider organizations: Most mental health professionals have a state association that lists provides in that profession (e.g., psychology, social work) in a given geographic area.
For more information:
American Psychological Association: <https://www.apa.org/helpcenter/index.aspx> or
National Alliance for the Mentally Ill: <http://www.nami.org/Content/ContentGroups/Helpline1/Mental_Health_Professionals_Who_They_Are_and_How_to_Find_One.htm>