You might think the fight over mental health parity — the requirement that health insurance plans not handle coverage for mental ailments any differently than coverage for any other disorder — would be over.
You would, however, be wrong.
Even though a federal law requiring parity, passed in 2008, has now been in effect since last October, there's the not-so-small matter of regulations for making the law a practical reality.
It turns out that interim regulations issued by the Department of Health and Human Services in late January are causing a bit of a dust-up of their own. The law says insurance companies can't charge deductibles for mental health care that are higher than those for other types of care. But can insurers impose two separate deductibles each year? One for mental health care and one for everything else?
HHS says no. "A plan may not apply separate deductibles for treatment related to mental health or substance use disorders and medical or surgical benefits-they must be calculated as one limit," the department said in its press release on the regulations.
That came as a relief to many of the advocacy groups that had been working to hammer out the rules. The American Psychiatric Association called the requirement for a single deductible "another victory" in the regulations. "Patients with mental illness often have general medical conditions that require treatment at the same time," the APA said in a statement shortly after the rules were issued. "Separate deductibles prevent access to mental health treatment,"
But on Monday, just as the comment period for the regulations was set to close, UnitedHealth Group, one of the nation's largest health insurers, objected.
United said in a letter to HHS that the regulation goes "beyond the intent of the 2008 parity law, and, in doing so, creates complexities that will have unintended, negative consequences and will disrupt access to appropriate behavioral health care."
Specifically, United warned that if it cannot offer separate deductibles; for example, $250 each for mental health and other care, employers will combine them into a single, $500 deductible for everyone. (Here's a summary of the company's position.)
"In this scenario, the impact is not limited just to those plan participants seeking mental health or substance use disorder treatment," United said in its comments. "This change will also result in greater out -of-pocket costs to plan participants seeking medical care — rather than meeting the previous separate $250 deductible for coverage of medical benefits, the individual will now need to meet the higher combined deductible."
Oh, and United is also asking for a one-year delay in having to meet the requirements of the new regulations; from July 1, 2010 to July 1, 2011 "to allow proper transitioning and implementation."
You can read UnitedHealth's full comments here.