Note to Health Insurers: Brain is Part of Body!

You’ve probably heard the term mental-health parity. But do you know what it means? Many people do not.

It’s important, because  recent healthcare reforms have called for mental-health parity. That is, reform provisions are designed to address the disparity between the limits insurance coverage sets for medical conditions involving the body  versus much more limited coverage for “mental health” conditions involving the brain.

Hey, but last I looked, the brain is part of the body!  Change happens slowly, it seems.

Mental health advocacy groups such as CHADD, the national non-profit serving the ADHD community, have long lobbied that medical conditions affecting the brain should be treated no differently than medical conditions affecting the heart, limbs, lungs, and so on. (Click here to review CHADD’s updates on this topic over the past few years.

Predictably, there’s a tussle over enforcement of these new provisions, reports Kaiser Health News (not associated with the Kaiser-Permanente HMO):

“Health plans that say mental illnesses can’t be treated like physical ailments are relying on an ‘outdated argument’ without merit that does not reflect ‘three decades of scientific research,’ 52 House members wrote in a recent letter to regulators. The comments come as a landmark law requiring parity in how health plans cover physical and mental illness went into effect Thursday. … The Mental Health Parity and Addiction Equity Act, [signed into law in 2008] requires that large-group health plans that offer mental health and substance-use disorder coverage do so on parity with their medical and surgical coverage. … The law applies to plan years starting Thursday, but some actuaries say most health plans aren’t ready” (Pecquet, 7/1).

This is part of Kaiser Health News’ Daily Report – a summary of health policy coverage from more than 300 news organizations. The full summary of the day’s news can be found here and you can sign up for e-mail subscriptions to the Daily Report here. In addition, KHN  reporters and correspondents file original stories each day, which you can find on KHN’s home page.

I’m certainly no expert on healthcare policy, but I do recall the runaway costs of drug-treatment programs many years ago; perhaps that had something to do with limiting healthcare coverage in this area, and was perhaps well-advised.  Some of these programs were little more than mills that soaked not only the insurance companies but also the hope and dreams of clients and their families. Recidivism rates were high.

Today, however, we know much more about the physiological underpinnings of substance use disorders. For example, addiction often obscures an underlying disorder such as ADHD, bi-polar disorder, or anxiety disorders. If the primary disorder is not treated, chances for full recovery are often doubtful.  Let’s hope that healthcare reform includes new paradigms for recognizing and treating these medical conditions affecting the brain as well as their behavioral components.

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