Insured and Not Covered: The Impact of Insurance Limitations with Mental Health

Insurance Limitations with Mental Health


It’s the nine-letter word that causes so many of us to cringe in anticipatory dread.

What’s your deductible? Is that provider covered under your plan? Do you need a referral from your primary doctor?

It seems we are at the mercy of our insurance plans at an increasing pace these days.

So much of what we can access for care and treatment of our illnesses depends on the whims of the insurance giants. In a money-making business such as insurance, arbitrary rules about what types of treatments and procedures are covered can make or break our overall health.

Mental health in the world of insurance is even more complex and disheartening.

Often providers of mental health services have to be mindful of their client’s coverage options, impossibly high co-pays and out of pocket coverage for those services not deemed “legitimate” by insurance companies.

Certain mental health diagnoses are highly scrutinized or outright denied by insurance companies, leaving consumers responsible for treatment that they had rightfully assumed would be covered. It seems that consumers and providers are under represented in the insurance game, and the people who are benefiting the most from these injustices are the large corporations making the rules.

Insurance companies have legal obligations and oversight, just as any public-serving entity.

Because of public concern regarding the lack of mental health coverage by insurance companies, the mental health parity law was passed in 2008 that holds insurance companies responsible for covering mental health services equal to that of physical health services. Even with this provision, many necessary services are cut short or not covered at all; it seems to be an unenforced law with good intentions.

Even services that are covered often have impractical and arbitrary time-limits imposed.

Treatments such as Cognitive Behavioral Therapy require a longer length-of-stay than many physical health treatments. This can create an “apples and oranges” comparison with which it is difficult to create true parity.

Trauma-based work is even more complex and cannot be expedited to meet the demands of an insurance company. Human emotions and the physiological components of trauma have their own timeframe.

While it is understandable that certain restraints had to be placed on coverage to prevent fraudulent use of resources, there must be a happy medium that meets the needs of consumers.

The impact of the limited coverage for mental health results in negative outcomes for consumers.

With limitations on amount of coverage for services and lower rates for mental health providers in agencies than in medical settings, many mental health agencies and individual practitioners are opting to avoid becoming credentialed with certain companies.

This results in limited access to services for consumers, as there are too few mental health providers offering covered services in many areas.

Our culture is becoming more health conscious and deliberate in our efforts to care for our minds and bodies.

Increasingly, we are seeing trends toward meditation over medication and a focus on attending to the entire self as a unified entity.

These trends are in line with our cultural values and insurance companies need to catch up to meet the needs of consumers and represent the shifts our society is demonstrating.

Responsible delivery of service to consumers should mean properly covering the needs of those enrolling in insurance plans.

Currently, people feel hemmed in by the limitations of their plans. Better plans are often far too expensive for the average American. Lower insurance rates mean we only have access to high deductible plans, forcing people to place their physical and mental health needs into a hierarchical and often survival-based stratum.

If financial resources are limited, which they often are for people who are forced into a high-deductible plan, this means that either physical or mental health needs get benched.

No one should be forced to choose between a healthy mind and a healthy body.

If we are truly going to embrace a preventative and proactive approach toward healthcare, it needs to be backed up by insurance plans that are effective.

Advocate for Change

It may feel futile to think about the long-standing issues of insurance coverage and the needs of the underinsured. There are ways to advocate for change and make your voice heard.

Write to your legislators:

Contact your state and federal representatives to discuss your concerns about healthcare coverage and mental health parity issues.

Reach out to disability rights advocates:

Connect with disability rights centers in your state to learn about opportunities to help with advocacy for mental health insurance coverage in your state.

Join forces with others for social justice:

Start talking to people about your concerns. Write an op/ed piece in some newspapers and start a dialogue on your social media feed. The more people talk about it, the more it takes on its own momentum and this is how revolutions begin. Be tenacious.

As much as we gripe about insurance companies, they are an important part of our access to healthcare, particularly if something catastrophic happens with our physical health.

The best thing we can do is advocate for change to ensure that our insurance companies offer adequate coverage to meet our physical and mental health needs.

Whether you can afford a high-end plan or are stuck with a plan that doesn’t even cover necessities, it is in our collective best interest to attend to these issues and repair the disconnect between consumer needs and what insurance companies offer.

Allowing for status quo simply perpetuates a long-standing problem that relegates mental health as an unnecessary service.

For people with depression, anxiety and other diagnoses, quality of life is negatively impacted in the absence of mental health services.

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