Sunday, February 22, 2009

Good change

Year after year I can remember my father reminding my mother's doctors that they had only 60 days to get my mother's mind back in the real world and taking her medicine correctly. He would say this because after 60 days the wonderful private psy-ward care was going to all be paid for by his cold, hard cash. The insurance and medicare would only cover for that long no matter what condition the patient was in, so this new legislation is great news for the mentally ill.

Insurance coverage for mental illness is catching up in Texas

Twenty-five years ago, Bob pressed a .45-caliber pistol against his head, straining against the desire to die.

"I felt the cold metal on my temple," he said. "It took every single [bit of] strength I had in my body not to pull the trigger to blow my brains out."

This January, a lifelong struggle with depression resurfaced dramatically. Stressed out and overworked, Bob, who is in his 50s, wanted to hurt himself again. He imagined hanging himself at the front counter at work or by the boss’s office. Bob rediscovered hope at Millwood Hospital in Arlington, receiving outpatient treatment five days a week for a month.

Then, still hurting, he was told his insurance was going to run out Friday.

"Here you’re somewhere where something is helping and you need more of it, and you don’t have enough," said Bob, who works in Tarrant County.

Unlike treatment for cancer or heart disease, some insurance companies cap treatment for mental disorders such as depression, which can be just as deadly. Treatments for other general-health conditions are often unlimited, several experts said.

But that’s changing in Texas.

Since October, insurance companies in Texas have been required to provide as many outpatient visits for mental-health services as they do for physical illnesses, according to the Texas Department of Insurance. Insurers have until June to show that policies and "evidences of coverage," such as forms, are compliant.

The parity ruling applies to companies with at least 51 employees. Small businesses are affected only if they elect to provide mental-health benefits to their employees, Insurance Department officials said.

One state lawmaker wants to go further and has filed a bill to raise the lifetime limits on mental-health services.

And next year, the federal Mental Health Parity and Addiction Equity Act of 2008 will take effect, establishing equal treatment for both mental-illness and substance-abuse conditions.

"It ends the discrimination between treating general health and mental health," said Julio Abreu, senior director of government affairs for Mental Health America. "It says that mental health is fundamental to one’s overall health. It does so by ending arbitrary limits that had not been based on medical treatment."

But some in the insurance industry say Texans will end up paying higher premiums as a result.

"A lot of employers are struggling to pay the premiums that they have right now," said Will Haff, media chairman for the Texas Association of Health Underwriters. "So you’re talking about increases.  . . . That’s not something a lot of them are going to swallow."

The Congressional Budget Office estimated that parity of medical coverage would increase health insurance premiums by an average of 0.4 percent.

Because of absenteeism and other problems, the cost to employers of untreated and mistreated mental illness has been estimated at $113 billion annually, according to Mental Health America.

Costly treatments

Administrators at two local psychiatric hospitals, Millwood in Arlington and Texas Health Springwood hospital in Bedford, said co-payments and deductibles often take patients by surprise.

And even though Texas law had required that patients be provided 60 outpatient mental-health visits a year, some people ran out of benefits and had to pay out of pocket to continue treatment.

"It’s not too frequent, but it does happen," said Ramona Osburn, director of Springwood hospital and Springwood outpatient centers in the Metroplex.

In such cases, patients are informed of the full cost they have to pay.

"We also have an extensive list of resources that we can give the patient," Osburn said. "We help them get into a different program if that’s what they want to do."

Jane Phillips, director of outpatient services at Millwood, also said she’s seen people run out of benefits.

"That certainly does happen where they have just a few visits for the year," she said. "What we’ve seen more and more is that people have really high co-pays or very high deductibles."

Bob, who feared being stigmatized if his full name was used, said he had to pay more than $1,000, including a $500 deductible, just to begin treatment for the first two weeks.

Then his co-pays were about $50 a day, he said. He had to put much of it on his credit card. When he learned he was out of insurance benefits, he realized that "I would be stuck because I have no way to pay for it."

State law requires that co-payments be the same for the treatment of any illness, mental or physical.

As for parity of outpatient visits, Texas law was unclear until last year. It once stated that large companies had to provide at least 60 outpatient visits for serious mental illness.

But the law was recodified in 2003 to require the same coverage for mental and physical illnesses.

Even though the law was on the books, it wasn’t enforced by the Insurance Department, said Doug Danzeiser, a deputy commissioner.

"We were treating it under the prior language," he said.

The Texas attorney general clarified in October that group health plans must "provide the same number of visits for serious mental health" as for physical health.

Rep. Valinda Bolton, D-Austin, said the attorney general’s opinion doesn’t address lifetime benefits. She wants her bill to accomplish that.

"That’s probably the biggest issue," she said. "It doesn’t say, well you know you can have a $2 million [cap] on physical health and a $50,000 cap on mental health. The ruling, to my understanding, does not address that issue."

'An illness like any other’

Bob caught a lucky break. He was given an extension on his insurance benefits so he could continue visits at Millwood for five more days.

Though he said that probably isn’t enough time, he was grateful. His employer said he may have been limited to 30 office visits if he was not diagnosed with a serious mental illness.

"The depression stuff, it gets so bad you don’t want to talk to anybody," he said. "I’m like a bear that gets into my cave. All I want to do is hibernate, sleep."

And he feels guilty about missing so much work because he likes to help others.

"Lately I haven’t been able to help anybody," he said. "I needed to help myself."

Robin Peyson, executive director of the National Alliance on Mental Illness of Texas, said state and national laws have reflected for too long the persisting stigma about mental illness.

"Its roots go back to 200 years to where people thought mental illness was a moral issue or a character issue," she said. "Science and research clearly indicates that it’s a brain disorder. Mental illness is an illness like any other."

What’s covered The Texas attorney general has ruled that serious mental illnesses must be covered with as many outpatient visits as physical illnesses. Serious mental illnesses are defined as:

Bipolar disorders (hypomanic, manic, depressive and mixed)

Depression in childhood and adolescence

Major depressive disorders (single episode or recurrent)

Obsessive-compulsive disorders

Paranoid and other psychotic disorders

Schizoaffective disorders (bipolar or depressive)


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