Monday, July 10, 2006

Mental Health

Some Ohio families struggling with mental illness are discovering that health insurance doesn't pay nearly as much to cover their bills as it would for physical ailments.

In Ohio, insurance companies usually cover no more than 20 mental health visits and 10 hospital days a year for hundreds of thousands of families. The maximum coverage for general health is typically $1 million over a lifetime, compared to $10,000 for mental health.

This is not unique to Ohio. Most health plans place restrictions on coverage for DAMN (drug, alcohol, mental, nervous) coverage.

For Susan and Donald Mikolic, treating bipolar disorder in both of their teenage sons and other mental health problems in the family, including their own depression, has created $500,000 in debt over the past decade. They have had to sell their suburban Cleveland house, and have paid as much as $500 a week, mostly from their own pocket, so all four of them could see a psychiatrist

Mental health treatment can be expensive. Many times there is no cure and no way to measure progress. Sometimes there are abuses of the system by providers who will treat up to the point where insurance runs out and then announce the patient is better.

Some Ohio lawmakers have tried to prevent insurers from restricting coverage for mental health. In 35 states, insurers are required to cover mental illnesses the same as physical ones.

There is also a federal law, the Mental Health Parity Act (1996) but this law only applies in certain situations.

MHPA applies to most group health plans with more than 50 workers. MHPA does NOT apply to group health plans sponsored by employers with fewer than 51 workers. MHPA also does NOT apply to health insurance coverage in the individual market.

But insurance companies and small business owners argue that such coverage would increase their costs

There is no question that premiums would have to rise to cover this additional liability. Just as HIPAA has created an undue burden on small employer group plans, expanding the MHPA to small employer plans and individual coverage could cripple an already pricey plan.
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