The 2008 Act closed up some of those loopholes. For example, the 1996 MHPA allowed employers to limit the number of visits for treatment whereas the 2008 Act states that mental health benefits can be no more restrictive than medical benefits.
The new law attempts to make coverage for these benefits equivalent to medical service benefits. If a health plan allows for out of network benefits for medical services, they must now allow the same out of network benefits for mental health treatment.
The major provisions for the new law are:
· Does not allow employers or insurers to place stricter limits on mental health services than they have on medical benefits. This means not allowing higher co-pays, deductibles or limiting the number of visits.
· If a policy allows for out of network benefits for medical benefits it must allow the same out of network benefits for mental health.
· If a policy allows benefits for substance abuse, both in and out of network, the limitations cannot be more restrictive than they are for medical benefits.
· Any state parity measures are left in place.
We currently see many policies paying only 50% of the allowable with the patient responsible for the remaining 50%. Under the new law this will no longer be possible unless the health plan pays only 50% of the allowable for medical benefits as well as psychotherapy visits. We have even seen health plans that pay only $10 per visit for psychotherapy.
The Act unfortunately does not cover all insured people. Employers with 50 or less employees are exempt from this Act. Also, the law does not require health insurance plans to cover mental health and substance abuse disorders. It only applies to plans that have coverage for mental disorders or substance abuse.
What does this mean to psychiatrists, psychologists, and therapists? These providers will not see as much discrimination for their services. Patients will not be penalized for seeing treatment and will receive equal benefits.
It’s not a perfect solution and doesn’t cover everyone, but it is definitely a step toward equal benefits.
The health system has complex laws that are not fully understood by most medical practitioners and patients alike. Because of this, employing the services of a health care attorney is therefore imperative in order to have better grasp on these governing laws. Lawyers who specialize in this kind of laws can provide medical practitioners and organizations with medico-legal counsels that are essential for the improvement of providing medical services to people.
