It occured to me this morning that I had been working in the field of 3rd Party Reimbursement for more than 31 years now. I have seen the changes and watched it evolve. In the early days there were not many insurance companies covering mental health. Medicare did not even cover it when I first began. There were a handful of insurance companies that would cover mental health services but usually on a very limited basis. The changes have not all been good or bad and I have adapted to all of them. Still there is a common problem that has not changed. In the beginning the very wealthy could get mental health services and the very poor. This has not changed. The hard working middle class still has the problem of adequate coverage for mental health services.
I recall a situation back in the 80’s where a young girl who had some sort of explosive disorder. I don’t recall the exact diagnosis but she had been place in a private inpatient unit. After so many days the insurance benefits exhausted and the hospital was ousting her even though her treatment had not not been completed and she was still a danger to herself and others. I worked with the mother and the insurance company on this case to get those benefits extended and we moved the patient to another hospital that was more reasonably priced and had a good success record. The young girl was treated for several more months and then released to a halfway house. I lost track of what occured next but this was the 80’s. The first hospital has since gone out of business and it’s treatment or rather lack of treatment and high cost were very much publicized when it went bankrupt in the early 90’s.
Some folks have good insurance through their employers while many are just struggling to get by and purchase a basic healthcare policy. When an individual is looking for an insurance policy or even an employer the mental health benefits are not usually high on their list of priorities. So as a result what we are seeing are large deductibles and large co pays which make the access to mental health services for those folks unaffordable. A 45-50 co payment for a client is pretty much unreasonable considering the allowable in most plans is between 50-80 for a therapeutic hour session. Some plans pay a little more some a little less in their allowable. This all depends on geographics and the discipline of the provider. But this is the general range of reimbursement.
So as the tragedy in Newtown and the tragedy in Aurora weigh heavy on our minds these days and what we are going to do to address this growing problem, the discussion about better access to mental health services has to be on the top of that list. I am not sure what has happened as a society that we are spawning these deeply disturbed and violent individuals,but if we are to attack this problem we must also attack the issues that many parents have concerning better reimbursement for mental health.
The insurance reimbursement for mental health services though improved with the passage of mental health parity a few years back it still needs a lot of work. It only applies to large employer groups and not individual policies. I don’t know that I have any answers about what we need to do but I would share what I have learned through the years with those that can make a difference and stop all this pain.