Local health officials hail new insurance law

Providers must cover mental health, addiction same way as physical illness

Local health officials said they expect more people will seek help earlier for mental health and substance abuse problems, and that they would be able to treat more people facing such issues, now that insurance companies are required to cover visits to therapy and drug rehab the same way they cover visits to the doctor or the physical therapist.

On Nov. 8, the Mental Health Parity and Addiction Equity Act was finalized. The law prohibits companies that provide group health plans from providing unequal coverage for mental health and substance abuse treatment compared to what they would normally provide for the treatment of physical illnesses, such as heart disease, a broken bone or cancer.

"We're excited about that," said Michael Fitzgerald, director of behavioral health for El Camino Hospital, "It means that there truly is parity."

Previously, Fitzgerald explained, many people would get either insufficient treatment or no treatment at all for their addictions and mental afflictions -- either because their insurance would not provide enough coverage, or because their insurance didn't provide coverage at all.

Now, with the parity act finalized and Obamacare requiring that all insurance plans cover mental health and addiction services, Fitzgerald said he anticipates the hospital's behavioral health services division will be able to help more people suffering from conditions such as alcoholism and schizophrenia.

Fitzgerald said the law will require insurance companies to discontinue "unfair" practices -- such as charging higher co-pays for mental health services as opposed to physical health services, or discontinuing coverage of a rehab after 10 days, even though the standard length of an effective rehab program is eight weeks.

Insurance companies also often required doctors to check in with a doctor employed by the health care provider on a regular basis in order to explain why a patient admitted to the hospital for an overdose or a psychotic episode needed to remain in the hospital, Fitzgerald said. Sometimes the insurer would require the doctor to check in after the very first day. Some interpreted this practice as a deliberate ploy to force doctors to discharge patients quickly and thus reduce the amount insurers would end up paying to a given hospital.

At the Mountain View branch of CHAC -- the Community Health Awareness Council -- executive director Monique Kane said she was happy to hear about the finalization of the new law.

"Sounds good!" Kane said.

While CHAC aims to make sure everyone who comes through its doors receives treatment -- operating on a sliding scale payment system -- Kane said she believes that, with more people on insurance plans that cover mental health and substance abuse with fair reimbursement rates, her organization will be able to help even more struggling patients.

Fitzgerald said he believes the new law will have another, more general positive effect.

"The big message is the stigma," he said, referring to the fear or shame some people feel that prevents them from seeking help for these conditions.

Having a mental health condition should be viewed the same way as having a heart condition. It's something that can be treated, Fitzgerald said.

"What this legislation says is that it's like any other condition. It's treatable, the treatment really works, and we need to take it out of the shadows."


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