Guest column: Insurance companies need to bolster mental health coverage - Grand Rapids Business Journal

Guest column: Insurance companies need to bolster mental health coverage – Grand Rapids Business Journal

With the annual open enrollment period kicking off and Michiganders looking for their best health insurance options for 2023, one key topic continues to dominate healthcare discussions: mental health care.

According to the National Council for Mental Wellness, 1 in 5 adults (52.9 million) in the United States suffered from mental illness in 2020, including 1 in 3 young adults aged 18-25. Suicide is the second leading cause of death among people aged 10 to 34.

In Michigan, a estimated at 1.3 million people have some form of mental health problem.

Lack of treatment

We face a growing mental health crisis in our country. More and more people are seeking treatment, but many don’t qualify for free or reduced care, don’t have the coverage they need, or are unable to afford the high cost of care. A shocking 54% of adults with mental illness receive no treatment.

Much of the blame lies with insurance policies that are woefully inadequate when it comes to taking care of mental health.

While improvements can be made in public and private health care, private insurance plans often provide poor coverage, low reimbursement rates for caregivers, and a very limited set of mental health services. The result is that hundreds of thousands of our fellow Michiganders do not receive the comprehensive mental health care they need and deserve, and some do not receive treatment.

Residents with anxiety and depression are often denied treatment, resulting in serious, long-term disruption and repercussions on their work, life and family, including bankruptcy.

Michigan Residents Support More Affordable and Accessible Mental Health Coverage Levels: Research Released This Summer by Consumers for Quality Care showed that 89% of Michigan voters believe that insurance should cover a wider range of mental health care and related prescriptions.

Treat health the same

Mental health should be considered on an equal footing with physical health care, but this is currently not the case.

For example, you may need an annual visit to your GP, but the average treatment for outpatient psychotherapy is six sessions. Current parity laws, which set similar copayments per visit for mental health and physical health care, would require the patient to pay six times the copayments for a standard course of mental health care compared to to physical health care.

In addition, a range of standard and long-accepted, evidence-based services may be needed by mental health patients, ranging from respite services, in-home services, case management, nursing homes emergency, reception centers or help in finding housing and employment. . These are benefits that many Michiganders receive through public programs like Medicaid, but are mostly absent from private plans.

Even when coverage is provided, it is often a miracle to find a mental health care provider – the result of the very low reimbursement rates that insurance companies pay providers. Instead, people trying to access mental health care will often find the list of mental health care providers to be a “ghost network,” meaning providers do not accept patient insurance. or have very long waiting lists.

Another factor is the massive growth in alcoholism and drug addiction in recent years. Coverage for these conditions varies widely, with key drugs often excluded, making it difficult to access treatment. Standard treatments that should always be an option are often not available and, due to the stigma of addiction, people are often afraid to fight for their right to care.

Then there’s the secret that many don’t even realize: Many mental health care providers don’t even take out insurance and work cash-only. About half of the country’s psychiatrists take no insurance because of low reimbursement rates.

If you are lucky enough to find one that will accept your insurance policy, they can be booked for months. So if you have urgent mental health needs, you’re on your own. This is an unbearable situation for those struggling and trying to resolve mental health and addiction issues.

Real parity

For Michigan residents looking for their next insurance policy during open enrollment, reading the fine print on mental health coverage can be an eye opener. Companies offering these policies must commit to making the changes needed to increase transparency and achieve “real parity” in mental health. To achieve parity:

  • Co-payments must be reduced for mental health care
  • Networks need to be expanded to increase the number of mental health care providers accepting new patients
  • Provider reimbursement rates need to be increased so they can afford to see clients with insurance
  • A full range of standard and long-accepted mental health services should be available to patients

If this is achieved, all Michigan residents will have access to the care they truly deserve, a chance to recover, and the opportunity to live full and healthy lives.

Robert Sheehan is CEO of the Community Mental Health Association of Michigan.