Mental health benefits not as good as medical coverage | SummitDaily.com

Mental health benefits not as good as medical coverage

Jennifer Brown
The Colorado Sun
Rep. Lisa Cutter listens with fellow colleagues to the State of the State Address. Gov. Jared Polis gives his first State of the State Address to a joint session of the state legislature at the state Capitol on Jan. 10, 2019, in Denver, Colorado.
Kathryn Scott | THE COLORADO SUN

Like most dads, John Cooke would have done anything to save his daughter.

He was lucky he had the money. To make her well, to make his teenager want to live and stop planning her suicide, Cooke and his wife would end up paying $150,000.

With each denial from the family’s insurance company, the Cookes wrote another check. When the company deemed it no longer “medically necessary” for their teenager to stay in a residential treatment center in Wisconsin, or another center in Utah, the Cookes paid out of pocket until the doctors said she was well enough to come home.

Throughout the year-long saga, Cooke, a marketing consultant, wondered more than once how absurd the company’s denials would sound if his daughter had another kind of life-threatening disease — not one of the mind, but the body. Would they, he thought, say she had reached her limit on treatment for cancer or diabetes?

It has been more than a decade since the federal Mental Health Parity and Addiction Equity Act was passed in 2008, mandating that insurance companies provide the same coverage for illnesses of the brain as for physical conditions — if they offered mental health benefits. The Affordable Care Act, commonly called Obamacare, went further, requiring insurance companies to cover mental health care and addiction treatment beginning in 2014.

But that’s on paper. In real life, mental health parity in insurance is not happening, according to multiple research projects and the stories of those who try to get coverage for treatment of depression, anxiety and addiction. Insurance companies in Colorado pay mental health doctors 30 percent less than they pay other medical professionals, and consumers have to pay for out-of-network care seven times more often than they do for other medical care.

“It’s the law of the land, but it’s not really happening,” said Dr. Carl Clark, CEO of the Mental Health Center of Denver.

The reasons for the disparity — set in place decades ago, when mental health care was isolated from the rest of health care — are multiple. Determining what is “medically necessary” in mental health is more loosely defined than in the rest of medicine. Federal and state regulators are often too overburdened to enforce parity laws. Also, there is a shortage of mental health professionals, and only a portion of them contract with insurance companies because they can make more money accepting direct payment from patients.

Those in the business use the term “ghost network,” meaning an insurance company might provide a long list of mental health providers in network, but hardly any are actually accepting new patients.

In Colorado, which passed its own parity laws in 1997 and 2007, legislation introduced this week would add more teeth. House Bill 1269 aims to close loopholes and force insurance companies to provide proof to state officials that they are complying.

“The reason that we have different types of health insurance — for physical and mental health — is because we made it that way in the 1960s,” said Dr. Benjamin Miller, chief strategy officer for the Well Being Trust, a foundation that focuses on mental health. “We are trying to right a wrong.

“It’s 2019, for heaven’s sake. It should not be separate.”

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