A young woman engages in a therapeutic session while seated on a couch.
Image Source: Sdi Productions | E+ | Getty Images
The Biden administration is set to take action against health insurance plans that discriminate against individuals in need of mental health care and substance abuse treatments.
A new proposed rule, released by the Health and Human Services, Labor, and Treasury departments on Tuesday, aims to ensure that health insurers comply with the Mental Health Parity and Addiction Equity Act.
The Mental Health Parity and Addiction Equity Act, passed in 2008, mandates that insurance plans covering mental health care and substance abuse treatments offer equal coverage for these services, just as they do for other medical conditions.
During a conference call with reporters on Monday, White House domestic policy advisor Neera Tanden expressed concerns about insurance companies evading the law, consequently making it difficult for patients to access mental health care.
Common obstacles faced by patients include a lack of sufficient in-network therapists, resulting in out-of-network care that incurs higher costs. Additionally, patients often need to obtain approval from their insurers for treatment, or experience denials that leave them responsible for the expenses.
Tanden stressed, “This has resulted in millions of insured individuals paying out-of-pocket when they shouldn’t have to.”
According to the National Institute of Mental Health, more than 58 million people, or over 20% of adults in the United States, live with mental illness.
The proposed rule will require insurance plans to assess how their coverage policies affect patients’ access to mental health and substance abuse treatments, as mentioned by Tanden.
If insurers are found to be non-compliant with the law, they will be obligated to take appropriate measures. This may involve expanding the pool of therapists within their network, should patients frequently seek out-of-network care, Tanden explained.
The proposed rule will undergo a 60-day public comment period before finalization.
A survey conducted by the research institute NORC, which included nearly 2,800 respondents, revealed that individuals with insurance face greater difficulties in accessing mental health services compared to other forms of medical care.
The survey found that nearly 40% of individuals enrolled in employer-provided insurance had to resort to more expensive out-of-network mental health care or substance abuse treatment, whereas only 15% did the same for physical health care.
Furthermore, over 50% of respondents reported that their insurance denied coverage for mental health or substance abuse services three or more times, in contrast to 33% experiencing the same with regards to physical health care.
In at least one instance, nearly 60% of those surveyed who sought mental health care or substance abuse treatment did not receive any care.
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