The New York State Psychiatry Association sued insurance provider, UnitedHealth Group Inc. (UNH), this week, March 11, citing UNH’s strict and miserly mental health care coverage violating mental health parity laws (Smythe, 2013). UNH provides insurance via group plans and Medicare, and additionally works with states and communities through Medicaid (UnitedHealth Group). UNH withheld and limited treatment and psychotherapy to patients with mental health disorders including anxiety and depression (Smythe, 2013). UNH faces further allegations in Minnesota for refusal to pay for continuing mental health care treatment (Smythe, 2013). The Mental Health Parity and Addiction Act mandates that group health insurance providers give coverage to those seeking mental health and chemical dependency treatment. While it is a nationwide act, there are similar state parity laws in California and New York, discouraging restricting mental health care.
Congress passed The Mental Health Parity and Addiction Act in 2008, but confusion and implementation problems remain rampant (Graham, 2013).
First, exactly how much needs to be covered? There are six categories of mental health treatment as defined in a government act issued in 2010: inpatient (in and out of network counting separately), outpatient (in and out of network also counting separately), emergency mental health care, and psycho-pharmaceuticals. While the government has clearly defined the segments, it remains to be seen which types insurance companies legally need to cover (Graham, 2013).
Additionally, what type of care precisely is required in different cases of mental illness and chemical dependency? According to the law, the insurance companies’ “medical management strategies” can determine what is necessary. While many in the mental health community disagree, saying that patients benefit from an individualized treatment protocol, I am fond of previous Democratic Representative Patrick Kennedy’s response (although I fully disagree with it), “if we can go to the moon and back, we can design algorithms that make necessary comparisons between mental health/substance abuse services and medical/surgical services” (Graham, 2013). You’re right—therapy for all (literally ALL insured and uninsured individuals); inpatient for all; and sober living for all; extended care; outpatient. Yep, my algorithms complete (not really). As someone who repeatedly lingered longer than everyone else at treatment center after treatment center and sober livings, I can say that what works for some does not work for all. Also, if it was so damn simple then why would there be a field of consultants to help individuals and families walk through the treatment process, creating an individualized and holistic plan?
Lastly, the actual enforcement of these legislative mental health landmarks is essentially unattainable. Simply admitting that it’s time for treatment, that you’re ready to go inpatient, that maybe some psychotherapy could help is hard. If you’re fighting an insurance company on top of that, facing financial incentives to remain in complacency, and feeling stigmatized by the system, it can be easy to slip back into complacency. Insurance companies are never easy to work with and create a chronic stressor with the less and less they’re willing to cover and the more and more difficult they become.
Different agencies are in charge of enforcement of the Mental Health Parity and Addiction Equity Act, and it simply has not happened (Graham, 2013). That’s what’s so cool about the lawsuit between New York State Psychiatry Association and United Health Group Inc. It is a step in the direction of accountability and furthering the affordability and availability of mental health care. On top of that, the Affordable Care Act promises increased availability to mental health resources based upon better Medicare prescription coverage, banning denial of coverage due to preexisting medical (including psychological) conditions, and more availability (Psych Central News editor, 2012). While there are undoubtedly many challenges ahead, mental health is becoming more available and the New York State Psychiatry Association v UnitedHealth Group Inc. is just one exciting development.
Graham, J. (2013, March 11). The Atlantic. Retrieved from Since 2008, Insurers Have Been Required by Law to Cover Mental Health–Why Many Still Don’t.
Psych Central News editor. (2012, July 2). Mental Health Care Benefits Under Affordable Care Act (Obamacare). (J. M. Grohol, Editor) Retrieved from Psych Central.
Smythe, C. (2013, March 11). UnitedHealth Sued by Over Mental Health-Care Access. Retrieved from Bloomberg.
Written by: Emily Friedles