Running head: THE BATTLE BETWEEN INSURANCE 1

The Battle Between Insurance and Mental Health Patients

Sport and Medical Sciences Academy

Aisha Chaudhry

November 9, 2016
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The Battle Between Insurance and Mental Health Patients

Mental Illness, the two words that cause everyone in the United States to take a sharp

intake of breath, and quickly avert their eyes, to avoid the impactful stigma that hits those who

are diagnosed, with a force that they can barely recover from. Mental illness is considered such a

taboo topic in America, considering that shame, self-consciousness, and pity are often associated

with it. Not only do people diagnosed with mental illnesses have to deal with the struggles of

battling their symptoms every single day, but they also have to face the fact that other people will

treat them differently. All anyone ever hears on the news about mental disorders is how it led to

the deaths of multiple children in school shootings, the suicides of hundreds of teenagers, or how

it is the silent killer that transforms an innocent person into a cold, heartless murderer. Because

of these images that society and the widespread media have fastened to mental illness, many

people have a negative connotation associated with it. Unfortunately, this is also a reason why

many individuals struggling with a disorder refuse to reach out, in fear of being harshly judged

and labeled by society like an item in a supermarket. If a person does have the courage to reach

out and seek help, they would feel overwhelmed at all the possible outcomes that could go

wrong, specifically the outcome of ones bank. The price for their health may be more than they

can afford considering medications are expensive. Perhaps they dont need prescriptions, but

instead need one-on-one therapy, which is also known to cost a pretty penny. Their insurance

may not cover all of portions of their regimen, if they even have mental health benefits at all.

Having a mental illness is already taxing by itself, but having it clash with insurance companies,

and lack of accessibility is a nightmare all on its own.

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Insurance companies are notorious for restrictions and methods that require reducing

cost, and increasing productivity for themselves. However, these businesses were challenged by

the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act that was

put into action in 2008 (American Psychological Association, 2016). It states that the number of

covered visits cannot be limited in mental health care, and that services for behavioral health are

comparable to physical health coverage. One would suspect that the passing of this law would be

joyous to the ears of patient. It was a law that had the possibility to solve multiple problems with

insurance companies, and finally allow patients suffering from mental health disorders, to get the

support that they need. Unfortunately, that is not the case. What insurance companies have

managed to do is slip under the cracks and slyly maneuver their ways around this relatively new

law. They have found ways to slither their way around the seemingly black and white statements,

and create further branching technicalities, as a way to avoid completely abiding by its

regulations (American Psychological Association, 2016).

Part of the Parity Law states that health insurance companies must have behavioral health

and substance-use disorders to be comparable to physical health coverage (American

Psychological Association, 2016). An exact percent of how many insurance companies in the

U.S. that cover mental health cannot be obtained, since every companys policies are varied

(AMerican Psychological Association, 2016). However some insurances, like Husky A, permit

the coverage of mental health care, and are partnered with a company in order to further aid

those who are diagnosed. Husky A specifically is in league with the Connecticut Behavioral

Health Partnership, and provides helplines to direct a patient to the nearest affordable clinic

(Beacon Health Options, 2016). If only all insurances were as compliant and resourceful as
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Husky. The loophole that comes with part of the Parity Law is that not all health insurance

companies have mental health as a part of their benefits (American Psychological Association

2016). This law only applies to the insurance companies that already have mental health benefits

listed. Therefore, this law doesnt require businesses to create a separate health care plan if they

dont have one, which is really one of the biggest steps that needs to be taken to actually benefit

patients with health care plans (National Institute of Mental Health, 2016). In order to advance,

another section, or amendment to that law would have to take place, requiring that all health

insurance companies include mental health benefits. The chance of this happening is very

unlikely, considering that it would be enforcing such a dramatic change that would rapidly alter

multiple companies policies across the nation. All insurance companies would have to

re-evaluate their health benefits packages and adjust the qualifications for each. The only recent

major change in insurance policies was the enforcement of Obamacare in 2010 (Health Network

Group, 2017). It was offered the citizens of the United States who perhaps couldnt afford

expensive health insurance policies, allowing them to obtain at least minimal coverage (Health

Network Group, 2016). Its doubtful that these companies would be willing to go through such

a process again, after being recently altered. Insurance companies just want to continue running

things smoothly from their offices, even though it would only benefit others to consider such

modifications, such as limiting number of visits.

The Parity Law clearly states that the insurance companies cannot limit the number of

visits that you have from a psychologist/psychiatrist (American Psychological Association,

2016). But the way that they have managed to wile themselves from this one, is by only granting

visits if they are medically necessary. For example, after a certain number of visits, they can
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withhold covering for the rest of a patients appointments until they are evaluated and cleared as

a result of a disorder. That process alone could take weeks, even months on end, and until that

period is over, the patient who cant function without therapy, therefore has to resort to paying

out of pocket for their treatment, if they are able to afford it. By putting up the barriers and of

medical necessity, insurance still has control over the number of appointments a person can

make. So even though a patient may require regular check-ups, the health insurance companies

will still put out a quota for the amount of times they can have a session. Not to mention, the

grounds for medically necessary vary for every insurance company. One company may deem

that one needs tests and diagnosis to confirm further treatment, while others may require

different methods of confirmation. (Which, by the way, are also not covered).

In addition to having your appointments reviewed, your treatment plan also has to be

reviewed in order to see if its plausible, and will actually make a difference to the progression of

the disorder (NAMI, 2016). Not only is this counterproductive, but it is actually restricting a

patients access to proper medication. For example, say a patient diagnosed with a disorder that

required a controlled substance as a part of their regimen, has been reviewed and suddenly

cannot have that medication anymore. Not only can the insurance company, remove coverage of

visits, but now they can also deem that medication isnt adequate to treat an illness (American

Psychological Association, 2016). One cant even argue against the company for their treatment,

unless they file an appeal. In most of the situations, an appeal process can also take months at a

time. If one is denied, one must file their claim within six months of their denial (Health Care,

2016). During this time, how is the patient supposed to function in their daily lives? Medication

is what is used as the backbone for most treatments. For instance, the National Institute of
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Mental Health states that for depression, antidepressants are most commonly used (National

Institute of Mental Health, 2016). If one that actually works for a patient is taken away, they will

have an extremely difficult time managing it. Sure, the insurance companies can replace it with a

different, perhaps more affordable medication. But what if that isnt the right one for the patient?

When a doctor prescribes medication, he/she has to take into account the side effects, the dosage,

and whether it worsens other aspects of the illness (NAMI, 2016). For a patient diagnosed with

bipolar depression, some medications bring out a patients mania while others focus to keep it

contained. Mania is classified by the dramatic shifts in mood and thought processes (Smith and

Segal 2016). That medication could have been the perfect solution to a patient's problems.

Without it, their whole world crumbles apart. For those who believe that people shouldnt just

rely on medication, and should focus on how they cope with their problems, remember that thats

not an option anymore since insurance companies decided to limit the amount of therapy that

you can get in a roundabout way. The second part to this law is that the treatment or medication

plan must also be supported with scientific treatment. Now, although most prescriptions have

been approved and tested for multiple years, this bodes a problem for the new innovative

treatments that have the potential to help many patients. Treatments like IV Ketamine and TMS

therapy, which were both developed fairly recently. TMS therapy was FDA approved in 2008,

and IV Ketamine therapy was established as a promising treatment for depression in May 2016.

(National Institute of Mental Health, 2016). IV ketamine is mainly used for patients who have

severe depression, and are constantly on the risk of committing suicide (Ketamine Advocacy

Network, 2015). Although most outside observers, who are unaware of ketamines advances in

mental health care, may seem skeptical at first, since ketamine was once used as street drug
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(Drug Enforcement Administration, 2013). However, in intravenous form, it actually promotes

neuronal growth, and allows the patients to become more focused on the recovery process

(Hamilton, 2012). TMS therapy, is a treatment that involves a magnet similar to an MRI, but has

more targeted and finite magnetic impulses that stimulate brain cells (Neurostar, 2016). Although

both of these treatments have had ample scientific studies to justify their validity, insurance

companies can still use the wildcard that says that these treatments are still new to the medical

field, even though they have been proved to treat both of the targeted disorders. If these

treatments are a last resort for the patient, then they will be forced to pay out of pocket if they

want to try them out.

Some health care providers dont accept insurance. At all. (American Psychological

Association, 2016). In that situation, it doesn't matter how much money for insurance is paid, or

how many benefits are in their deluxe family package. None of them will be applied. This is the

effect of companies refusing to change the reimbursement rates for psychologists, despite the

fact that the costs for running a practice increase by the day (American Psychological

Association, 2016). As a result, the only way to make a feasible profit off of their business is to

forego insurance, so that the profits go directly toward the paycheck of the psychologist and

his/her employees (American Psychological Association, 2016). Since most people rely on

insurance to cover their health benefits, the only option left is to pay for their care themselves. In

fact, in 1980, 71.4 percent of non-elderly Americans had health insurance coverage as an

employment benefit (Huberfield and Roberts, 2016). This is one of the reasons why some people

diagnosed with mental disorder won't continue to follow up with treatment. They may simply not

be able to afford the cost of regulating their illness, especially since some require additional
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treatment and specialized therapy besides the expensive prescription medications. For IV

ketamine, a single infusion can be between $400-$800 (Ketamine Advocacy Network, 2015)!

Its counterpart, TMS therapy, is no better. TMS alone is between six thousand to twelve

thousand dollars. (American Psychological Association, 2016). The only solace that patients

have for that treatment is that they can pay a deductible, and then file for reimbursement later on,

after the course has been finished. And even then, not even 100% of it will be returned (TMS

You, 2016). One will only receive a fraction of what they paid from their insurance, if they are

covered.

As a patient, this can be very frustrating, since mental illness is an issue just as important

as physical health, but it is somehow still treated with a diminished importance. No one tells

someone that they cant get their broken arm fixed, while patients with psychiatric disorders

cant go back and continue their treatment without a cost to them. The goal of this law was to

create equality between mental and physical health, reduce the costs of treatment, and to allow

patients to have the ability to see their doctor as often as needed. But the insurance companies

have made life for patients so much harder by zeroing in on loopholes, and trying to skate by

what the law actually intended to implement. However, it has become clear that there are still

barriers that need to be knocked down before coverage for mental illnesses actually makes any

progress.
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References

American Psychological Association. (2016). Does your insurance cover mental health services?

Retrieved from http://www.apa.org/helpcenter/parity-guide.aspx

Beacon Health Options. (2017). Connecticut Behavioral Health Partnership. Retrieved from

http://www.ctbhp.com/

Drug Enforcement Administration. (2013, August). Ketamine. Retrieved from

https://www.deadiversion.usdoj.gov/drug_chem_info/ketamine.pdf

Hamilton, J. (2012, October 4). Ketamine relieves depression by restoring brain connections.

Retrieved from

http://www.npr.org/sections/health-shots/2012/10/04/162299564/ketamine-relieves-depress

ion-by-restoring-brain-connections

Health Care. (2016). Applying a health decision internal appeals. Retrieved from

https://www.healthcare.gov/appeal-insurance-company-decision/internal-appeals/

Health Network Group. (2017). Obamacare may be no longer available after January 31st.

Retrieved from https://obamacare.net/

Huberfield, N and Roberts, J. (2016, 8 February). Decoupling myths about employment and

health insurance. Retrieved from

http://healthaffairs.org/blog/2016/02/08/decoupling-myths-about-employment-and-health-i

nsurance/
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Ketamine Advocacy Network. (2016). How much does ketamine therapy cost? Retrieved from

http://www.ketamineadvocacynetwork.org/cost/

National Alliance on Mental Illness. (2016). What to do if youre denied care by your insurance.

Retrieved from

http://www.nami.org/Find-Support/Living-with-a-Mental-Health-Condition/Understanding

-Health-Insurance/What-to-Do-If-You-re-Denied-Care-By-Your-Insurance

National Center for Biotechnology Information. (2010, November 12). The NeuroStar TMS

device: conducting the FDA approved protocol for treatment of depression. Retrieved

from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3159591/

National Institute of Mental Health. (2016). Mental health conditions. Retrieved from

https://www.nimh.nih.gov/health/topics/mental-health-medications/index.shtml

National Institute of Mental Health. (2016, May 4). Ketamine lifts depression via a byproduct of

its metabolism. Retrieved from

https://www.nimh.nih.gov/news/science-news/2016/ketamine-lifts-depression-via-a-bypro

duct-of-its-metabolism.shtml

Neurostar. (2016). About Neurostar TMS therapy. Retrieved from

https://neurostar.com/neurostar-tms-depression-treatment/

Shaddox, C. (2014, February 3). New class of antidepressants shows promise. Retrieved from

http://depression.yale.edu/newsandevents/article.aspx?id=6656

Smith, M and Segal, J. (2016, October). Is it Bipolar disorder? Retrieved from

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http://www.helpguide.org/articles/bipolar-disorder/bipolar-disorder-signs-and-symptoms.ht

TMS You. (2016). Insurance. Retrieved from

http://tmsyou.com/tms-patients/insurance-and-payments/
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