PART OF THE SOLUTION On board with parity

The definition of parity is fair treatment, though not necessarily the same treatment. Many years after deinstitutionalization in 2008, Congress passed the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPAEA) to safeguard equal coverage of treatment for mental illness and addiction. In November 2013, the federal government released rules to implement the law. Before this law, mental health treatment was classically covered at far lower levels in health insurance policies than physical illness. If a state has a tougher state parity law, then health insurance plans regulated in that state must adhere to those laws. For example, if state law requires plans to cover mental health conditions, then they must do so, even though federal parity makes inclusion of any mental health benefits optional.

What does the struggle for parity look like in a treatment facility or a hospital? There are designated days for each type of insurance during which a staff member must call to extend a patient's stay in a treatment facility for mental illness or addiction. The patient is all too aware of what is going on because too early a release will put that patient on the street, usually homeless and at risk to relapse. As the time comes close to the insurance call, the anxiety of the patient escalates and the patient becomes fear-filled. Where will I go? How am I going to survive without long term treatment? How will I endure? These are the thoughts ruminating through the patient’s mind. And their condition worsens while they are waiting for the answer. All the progress that has been made with the patient dissolves. Parents and caregivers are perplexed as to why a loved one might be discharged.

Clinicians or utilization review employees call with trepidation and know that their patient’s lives are on the line. These employees are subject to many questions, sometimes far beyond their expertise. One clinician, after being asked why she couldn’t find a bed in a transitional services program paid for by the Department of Public Health, replied, “There is an opiate crisis right now, so the beds are full.” The doctor for the insurance company said, “What opiate crisis?” Clinicians are afraid to tell the patients of any bad news on insurance coverage because of the strong emotional impact it will have.

So, why can’t an addict, alcoholic, schizophrenic or bipolar patient be treated the same way as any medical patient? We know now that addiction and alcoholism are a dysregulation of the neurotransmitter dopamine system. In short, once an addict begins using drugs the brain is tricked into thinking that it needs the substance and nothing else. We know that schizophrenia arrives like cancer. So, the young man who is attending MIT with honors is suddenly hit at age 21 with voices that command him to do things he would not ordinarily do. And the bipolar patient whose MRI of her brain looks much different than a normal brain can’t sleep at night. Don’t they have the same rights as a victim of a deadly disease? Yes, according to the MHPAEA; however, the reality is that the insurance companies are often violating these laws. Keep in mind that certain insurances are exempt. This includes retiree only plans, TRICARE, VA, Medicare and the Federal Employees Health Benefit Program. For the majority who suffer from mental illness and addiction and who are on Mass Health, there is hope in addressing the violations of the insurance companies.

Symptoms of violations often resemble the following: Higher costs or fewer visits for mental health services than for other kinds of health care. Having to call and get permission to get mental health care covered, but not for other types of health care. Getting denied mental health services because they were not considered “medically necessary,” but the plan does not answer a request for the medical necessity criteria they use. Refusal for inability to locate any in-network mental health providers that are taking new patients, but can for other health care. The plan will not cover residential mental health or substance use treatment or intensive outpatient care, but does for other health conditions.

Here's to the mental health professionals who have the courage to stand up for parity and fight for their patients, who deserve the same rights as someone with a terminal illness. They are a tribute to the words compassion, empathy and integrity.

— Caroline can be reached at Carrico@bu.edu