Mental Health Parity Act: Interim Regulations went into effect April 5th
New interim regulations for the federal Mental Health Parity and Addiction Equity Act of 2008 went into effect on April 5, 2010. Final regulations will be released at a later date. The new regulations apply to any group insurance plan with 50 or more members. The interim regulations provide that any health insurance plan that offers mental health or substance abuse benefits must provide them at a comparable level to the medical/surgical benefits provided by the plan. Private companies that provide mental health/substance abuse benefits are prohibited from having higher deductibles, co-payments or out-of-pocket limits for mental health/substance abuse services. Copayments and deductibles for mental health/substance abuse services must be included in the cumulative calculation of the insured's expenses (i.e., they can’t require separate deductibles or out-of-pocket maximums for mental health services.)
These plans are also prohibited from imposing day or visit limitations for in-patient or out-patient mental health or substance abuse treatment services.
The U.S. Department of Health and Human Services offers a help line to answer questions or hear concerns about your health plan’s compliance with the law. Call toll-free: 877-267-2323; ext. 6-5511. You can also send an email to: phig@cms.hhs.gov
The Balanced Mind Foundation wants to hear from you. Have you had an experience (good or bad) with the new regulations? Did your plan drop coverage for mental health benefits, which were previously offered? Are you experiencing any specific problems in getting coverage under the new regulations? Post your comments here.
Hi:
This is very interesting but it's only for mental services? It would be great to put a regulation also on medicines there are so expensive and the insurance plan have a limit in the meds coverage and the mental patient most of them needs the medicines for a long term.
Thanks,
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Annette
Mom to Derek age 8
DX ADHD, Bipolar
Concerta .27mg, Risperdal .25 day and 1mg night.
Randall age 5
DH Randall Earl 28
My english is not good. My daughter is 10 she has allucinations. the doctor said she have depression and " ansiedad"?, That was last november. and now the doctor says she is bipolar but I can't find any symptom, what can I do? She takes risperdal .12 day only, lexapro .5 day only and rivotril .25 day
I am currently getting ready to submitt one last appeal to our insurance company. They refused even the out of network coverage for day treatment saying it was not "medically needed". This after she had to take a medical leave from her college and had letters stating this from the University, Psychiatrist and therapist. The insurance company sent us a letter saying she was capable of working, supporting herself, etc with the support of her family.
I am going to send in the neurological report which states she had "abnormal" 48 hour EEG. I thought this might show there was a medical need to seek treatment.
Any suggestions?
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Neitcha
My experience with insurance companies is that the squeaky wheel really does get oiled first. Keep at it, and ask to speak with supervisors. Ask them specifically what they need to approve it. Make sure that you have "To Whom it May Concern" letters from her doctors stating the need for treatment, not capable of functioning, etc.
Best of luck,
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Susan Resko
Executive Director
Steve,
Thanks for your comment. It will be interesting to learn how the DSM committee responds to the feedback from the public on TDD and how they will proceed. Stay tuned, CABF will keep you informed!
Susan Resko
Executive Director