Sunday, October 5, 2008

Psychiatric Help 5 cents - The Doctor is In

Since shock, anger, denial are common reactions to a diagnosis of multiple sclerosis, and depression can be caused by the disease process itself, it's important to seek professional help when necessary.

But how does your insurance policy cover your mental health benefits? Does your insurance require higher copays for mental health visits as compared to physical health? Does it limit the number of visits which are covered during the year? Do you have to pay a percentage of the charge rather than a set copay?

The following is information about the Mental Health Parity Act of 2008 (originally shared on Health Central).

Congress has been trying to address the inequality of mental health benefits for over a decade and it is now included in the “Wall Street Bailout Bill” of all places. As you probably know, the Bailout Bill includes a few housecleaning extras. One of those extras (see page 310) is the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008.

This Act would improve the mental health insurance coverage for policy holders in group plans, but would not affect policy holders of individual plans or medicare. Also included in the legislation is a small business exemption for companies with fewer than 50 employees, as well as a cost exemption for all businesses.

The new Mental Health Parity Act does not mandate that group plans provide mental health coverage. It does, however, require that group insurance policies which do offer mental health coverage cannot impose separate financial requirements or treatment limitations as compared to medical surgical coverage. Basically, mental health must be treated in the same manner as physical health. The legislation developed in talks with mental health, insurance and business organizations to craft compromise legislation.

The 1996 parity law, authored by Pete Domenici and Paul Wellstone, provided parity for annual and lifetime limits between mental health coverage and medical surgical coverage. The new legislation expands parity by including deductibles, co-payments, out-of-pocket expenses, coinsurance, covered hospital days, and covered out-patient visits. It also requires that if in-network and out-of-network benefits are offered for medical surgical coverage, they must also be offered for mental health coverage.

So what does this have to do with multiple sclerosis?

Well, when you seek psychiatric expertise and/or talk therapy counseling services to address depression and the emotional aspects of MS, you will be covered the same as for other types of doctors’ visits.

Unfortunately this Act only applies to folks who have group coverage, are employed by a business with more than 50 employees. But it’s a great start!!

(More links are included in the commentary on the original post.)


  1. This is really good to know! Thanks for the great information - as always!

  2. I remember back in the 80's when the same legislation was attempted for alcohol/drug issues...Medicare/insurance tried to move ETOH/CD issues under medical coverage benefits versus standard psychiatry. This lasted for about 2 years...then, when the budget cuts hit (as they will again), the issue gets sent backward. The cost of psychiatric care in America falls primarily to the States, who's budgets simply cannot handle the rising cost of care with inflation. There is a shortage of psychiatric beds across America, people are being treated primarily in EMERGENCY ROOMS for their psychiatric needs, and the system is facing collapse.

    Just my two cents worth and now I'll jump off my soap box. LOL

    Linda D. in Seattle

  3. For the life of me I have never been able to see why mental health is any different than "physical" health. I always thought the brain was part of the body???

  4. Well, it's a beginning, and a LONG time coming.

  5. My therapy visits have copays that are more than double what my copays are for doctor visits.
    And the yearly deductible is double. Hmmmm....

  6. @ TherapyDoc - Do you think that this will make a huge difference? Or do you think that insurance companies in states without mandated mental illness coverage will simply drop coverage?

    @ Abby, Chris - My coverage is limited to 20 visits a year. Visits 1-5 at 10% copay, visit 6-20 at 50% copay. Visits beyond 20 at 100% billed charge (not even discounted).

    A couple of recent years when I was attending weekly sessions, my therapist worked out a deal with me. The year I was being diagnosed and ran out of visits, we picked a rate between 50-100% insurance's rate.

    The year NORD rejected my appeal for additional assistance with Copaxone, my therapist offered $10 sessions. But I still paid out $15,000 + for medical costs that year.