HOW TO MAKE SURE INSURANCE COVERAGE WORKS

How to Make Sure Insurance Coverage Works

by Alan M. Solomon, Ph.D.

Federal law guarantees that insurance coverage for mental health and addiction care should be equivalent to coverage for medical care, if the psychological treatment is for more serious difficulties.  All too often insurance restrictions create obstacles to many Americans trying to gain help.  There is a website now that provides information to help:  www.ParityRegistry.org , so that patients and their families trying to access care don’t have to give up when they face difficulties getting coverage.

This website provides help with:

  • Filing an appeal with a health plan
  • Step-by-step guidance for an appeal
  • Sending a complaint directly to state enforcement officials
  • Finding a list of state and federal regulators who can help with an appeal
  • Basic FAQs

Passed in 2008, the Federal Parity Law requires insurance programs to cover “illnesses of the brain” with equal benefits to those provided for medical care.  Depression and addiction are two such more serious illnesses.  Many insurers are not in compliance with this law, even though it is now 10 years in existence.

Typical violations include:

  • Making people pay higher co-pays or a separate deductible for psychological services
  • Limiting how many days someone can stay in an intensive treatment center, or how many times they can see a therapist
  • Making patients pay more for medications for psychological treatment than for medical treatment
  • Requiring permission to start, or continue, psychological services
  • Rather than allowing a patient to follow a doctor’s suggested treatment, making the patient try a less expensive treatment first
  • Refusing to pay for treatment outside of a patient’s state or home region.

Patrick Kennedy, a former congressman from Rhode Island, was a lead sponsor of this federal legislation, and one of the founders of the parity website.  He also founded the Kennedy Forum, which is the sponsoring source for this parity assistance.  As Kennedy put it, “No parent should have to face financial ruin to save their child’s life, especially after paying into an insurance plan diligently for years.”

Alan M. Solomon, Ph.D. is a clinical psychologist in private practice in Torrance, CA. A member of the Independent Psychotherapy Network, he can be reached at 310  539-2772 or dralanms@gmail.com

Copyright 2018 by Alan M. Solomon, Ph.D.