This post is dedicated to the lovely Alison, my die-hard Batman buddy and good friend. She was asking me the other day about why health insurance doesn’t cover mental health services (or at least doesn’t cover much).

I confessed that I didn’t know too much about it, so I’m writing this blog post as an answer to her question. I found out all I could about mental health related services and why they don’t seem to be covered by most insurances.

First off, there has been legislation passed to ensure mental health and addiction services are covered as equally as other health services. It’s called the Mental Health Parity and Addiction Equity Act, and it was passed in 2008. This act is meant to force insurance companies and healthcare providers to treat mental illness without discrimination in terms of coverage and importance. Unfortunately, it hasn’t been implemented.

With the Affordable Care Act passed, those insured through both online marketplaces and private insurance were supposed to receive more coverage for mental health services, yet they didn’t. The “final rules” of the act remain undefined, as well as the definition of what exactly a “parity” for mental health care is.

There are also issues with claims being denied, such as this instance noted by USNews.com:

Nearly a third of NAMI survey respondents reported insurance companies denied authorization for mental health and substance abuse care because the insurance companies deemed the care not medically necessary. “In the absence of uniform criteria, insurers have adopted their own standards and have often not been forthcoming about informing beneficiaries about these standards,” authors of the report wrote.

Denial of these claims by saying they aren’t “medically necessary” can lead those suffering mental health issues to self-medicate through drugs and alcohol, and in some cases patients resort to suicide. In my humble opinion, helping those with mental health issues IS medically necessary in order to prevent this from happening. Many people end up being incarcerated because of lack of treatment as well.

New provisions that did end up expanding mental health care seem to have remained a secret, as insurance companies, both in the marketplace and from private insurers, are failing to notify those insured of the changes. There are also various loopholes and insurance gaps some people fall into that prevent them from receiving care under the new provisions. Health insurance for mental illness is a right mess, and it doesn’t look to be getting any better.

Although premiums under the Affordable Care Act are lower than anticipated, those lower cost plans that people can actually afford have very limited coverage of mental health services. The plans that have significant coverage are still too expensive for those needing the care covered.

Another problem lies with those administering psychiatric services. Many psychiatrists don’t accept insurance, which seems to me like a bad move. Why wouldn’t they accept it? By accepting insurance, a whole multitude of those with mental illness could get adequate care, so what seems to be the problem?

According to an article from PsychCentral.com, “low reimbursement has been cited as a reason why physicians do not accept insurance.” The article goes on to say that the number of psychiatrists is significantly less than that of general or specialized physicians, and the number has been decreasing during recent years. Medical students are going for careers that are economically-savvy, and psychiatry just isn’t the most desirable profession to pay the bills.

The article states that psychiatry is one of the lowest paying medical professions, and since psychiatrists spend more time with their patients than regular doctors do, meaning they see less patients, they tend to charge more in order to make up for limited availability.

Something about that sounds odd to me, but it’s probably because I think of psychiatrists as spendy (mainly because over half of psychiatrists don’t accept insurance). It’s like we’re caught between a rock and a hard place. Psychiatrists need to make a living, but mental health patients need to receive care.

An article from Bloomberg Business makes a startling claim as to another reason why psychiatrists may choose not to see patients:

“Money isn’t the only issue. Many psychiatrists, particularly those in private practice, won’t take appointments with more complex patients like Derek Ward, who often have histories of drug dependency, multiple hospitalizations and deep psychosis. They say those types of patients are too time consuming, especially after hours, according to interviews with more than a dozen doctors and patient advocacy groups. One doctor says he also worries they could a pose greater risk of physical violence.”

Ironically, the fear of violence that leads psychiatrists not to provide treatment to certain individuals is the reason why some sink into suicidal depression or are lost to psychosis, leading them down a dangerous path where they are unaware of their actions.

Although those suffering severe mental illness are much less likely to commit violence than they are to be a victim of it, there are extreme cases in which they can become violent, such as in the case of Derek Ward, who was unable to get an appointment with a psychiatrist and ended up killing his mother and himself after running out of medication. He had been suffering with what doctors suspect was PTSD from the death of his brother and grandfather (whom he regarded as a father figure), and he had previously suffered deep depression.

I can personally attest to the effect medication has when you are forced to go cold turkey. There was a mixup on one of my medication refills when I was in college. They sent the refill to a Walmart in the town where my permanent residence was, not the town in which I was currently going to college. The situation left me three days without my medications. The only thing I remember from those three days was yelling over the phone to my mother in a Walmart parking lot.

There are so many factors going into why mental health patients aren’t getting the treatment they need. I could literally go on all day about this, but I’ll choose to end this blog post here. I think that what needs to happen is the finalization of rules for the Mental Health Parity and Addiction Equity Act. President Obama made an attempt to do this when he put forth legislation to help “stem gun violence,” but as this is a very contentious issue, stuffing the act into legislation that divided Congress effectively made the effort useless.

What we need is to have this act finalized as an individual piece of legislation without overshadowing it with another issue. Hopefully, if Obama doesn’t do it during his last year in office, the next president will find success.