The great irony of private insurance and mental health coverage

Jan 30, 2013

This week, our neighbors in Connecticut began hearings about mental health care in the state after the Newtown shooting. Lawmakers and a couple of task forces convened by Gov. Dannel Malloy are reviewing the state's mental health services and looking at the kinds of public policy and legal fixes that might make it better. Should we mandate outpatient treatments for the mentally ill? Can we truly assess someone's risk before it's too late? Should gun buyers face a mandatory mental health evaluation? These are some of the questions they're tackling.

The goal is understood: to prevent another tragedy. Whether getting more people with mental illness the treatment they need will prevent such tragedies, well, we don't know. Most experts I've spoken with tell me the only reliable predictor of future violent behavior is past violent behavior. That said, I'd rather place my bets on early treatment.

About that treatment...getting it, enough of it, when you need, might sometimes be tougher if you have private insurance.

If you get health insurance coverage through your employer, for instance, and you've ever needed, let's say,  inpatient treatment for addiction, or long-term behavioral health counseling, you might have come up against your plan's treatment limits. You might not have gotten the full 30 or 60 days you needed on an inpatient unit but instead been "stepped down" to an intensive outpatient program, only to end up needing that higher level of treatment anyway which your insurer still won't cover. You might have used up your 30 counseling sessions but find yourself still needing help.

If you did not have private insurance, however, you might actually have had access to more treatment options through publicly-funded programs.

There's this Associated Press account of a recent hearing in Connecticut about mental health services:

State lawmakers were told that individuals with private insurance have much more limited access to services than people using government insurance. Patricia Rehmer, commissioner of the Department of Mental Health and Addiction Services, said there are limits on the number of services that can be used annually, which can create problems for families.

"I am often called, especially by parents of young adults who are now keeping their children — young adults — on their insurance until they're 26, who need the services that we provide," Rehmer said of her agency, which serves only people without private insurance.

"They need case management. They need supportive housing. They need interactions with their peers," she said. "Those are things that private insurance companies do not pay for."

Rhode Island's department of mental health and substance abuse director Craig Stenning told me once that he was aware of the issue. The Providence Center is also thinking about it - helping close the treatment gap for people who have private insurance but can't get the treatment they need covered or afford the co-pays.

There is, I think, something to be proud about in terms of the resources available for people without means. Rhode Island has made great strides in that area, I'm told. But even people with private health insurance can struggle to pay for behavioral health care treatment their plans don't cover. And I haven't even mentioned the calls for better mental health parity, or covering mental and medical health equally.

Of course, not all private health insurance plans are created equally - some cover more than others. And private insurers might argue that they cover as much as they can without bankrupting the plan or charging exorbitant premiums.

I'd love to hear from you if you think this is a problem that needs addressing in Rhode Island.