Get Your Head In THIS Game - DC News FOX 5 DC WTTG

From Anchor Jeff Michael

Get Your Head In THIS Game

Posted: Updated:

In this evolved society of ours we talk openly about most medical issues; cancer, infertility, cosmetic surgeries, even sex change operations.  But when it comes to something gone wrong between our ears— there is silence, embarrassment, shame.

Mental illness and addiction has forever been the ugly stepchild of disorders and disease but there is a glimmer of hope that begins this week (actually it began with an Act passed in 2008 but arrives in full this week). It's called the Mental Health Parity and Addiction Act. Simply, it requires all insurance plans that offer any type of mental health coverage to improve that coverage up to the level of the major medical insurance offered.

Let me give you an example. Say I have PPO medical insurance. I'm encouraged to go to doctors that are in the network but not required to. I don't need prior authorization to go to a doctor and if that doctor prescribes, say, physical therapy for my sprained ankle, I am not limited to the number of treatments I receive; as long as the doctor prescribes it. But when it comes to mental health coverage, my employer's health plan (just for argument) chose an entirely different insurance carrier; one with a name that would send a chill down your spine if you were battling a severe problem. I'll call the company, Cheapest Choices. Cheapest Choices DID require prior authorization for any mental health treatment (counseling, testing, even sleep disorders if you go to a Psychiatrist for treatment). C.C. DID limit the number of treatments allowed. And if a patient wanted to go to a doctor outside the C.C. network, coverage was ZERO. ZIP. A catatonic stare back into the eyes of the hurting patient.

Now, all that must change BY LAW. Now, your options to receive counseling, psychotherapy, medication management from a Psychiatrist and more, must equal the options you have to choose an orthopedist or a gynecologist. Mental health advocates across the country are calling this a victory for millions of us. Unlike a broken bone, a broken mind, if left untreated can be fatal. Lives can be saved because of this.

But, to be clear, the fight for parity is far from over. Insurance companies have a little requirement they play called "Medical Necessity". Medical Necessity is a no brainer when it comes to physical illness or injury but try to apply that to depression or to the addict who has gone through detox but still hungers for his or her drug of choice… and you are in trouble. This is why insurance companies can and have created the "30 Day Treatment" standard for substance abuse. They know that after three or four weeks any addict or alcoholic who is sober will have no demonstrable Medical Necessity and therefore can be cut loose… only to relapse according to just about every statistic out there.

So I laud the big bad federal government for making insurance companies do what they should have been doing already. Maybe those companies will complete the task and completely reform without law makers forcing their hand. Or maybe I should be in treatment for that kind of optimism.

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