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Health Insurance Change Prohibits Pre-Set Limits

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Health Insurance Change Prohibits Pre-Set Limits

Health Care

Health Insurance Change Prohibits Pre-Set Limits

Health Insurance Change Prohibits Pre-Set Limits

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Last year Congress passed a sweeping measure that expands insurance coverage for mental illnesses. It went into effect in October. Insurance policies that cover both mental and physical health now have to cover mental health as fully as physical health. There is one cloud on the horizon: the regulations haven't been published yet.

LINDA WERTHEIMER, host:

We're bringing you the news on the Senate's health care bill this morning, but there's one health insurance change that is not dependent on the current debate in Washington. Last year, Congress passed a sweeping bill that requires some insurance policies to provide expanded coverage for mental health and substance abuse treatment. NPR's Joanne Silberner reports.

JOANNE SILBERNER: Right now, health insurance plans that include mental health coverage can limit hospital stays for mental illness to a set number of days, whether or not the patient is still sick when time runs out. They can also pay for only a set number of visits to a therapist. Some states prohibit those practices already, but the new law will prohibit the preset limits across the country, says Andrew Sperling of the National Alliance on Mental Illness.

Mr. ANDREW SPERLING (National Alliance on Mental Illness): This bill will require health plans to cover treatment for mental illness in some cities on the same terms and conditions as medical surgical coverage in health plans.

SILBERNER: Copayments for psychiatric treatment can be no more than for medical treatments. Same for out of pocket limits, deductibles, the percent of the bill covered by insurance. The law went into effect in October. Most insured people will feel it when their 2010 health insurance policy kicks in January 1st. It's going to help some people, but not others.

It will help Maxine Cunningham(ph) of Baltimore. Cunningham has major depression, bad enough to drive her from her high stress job as a senior housing analyst with the federal government. The fainting and the black days that accompanied her disease have gone away with weekly talk therapy and drugs. The current different between what her insurer pays for mental health coverage versus physical coverage galls her. For medical care?

Ms. MAXINE CUNNINGHAM: I would pay 30 percent of the cost, and the insurance company pays 70 percent of the cost.

SILBERNER: But for mental health, the insurer pays only 60 percent. It'll change to a 35/65 split for both medical and mental health care. And next year, there won't be an annual limit on the visits to her therapist as long as they're recommended by her doctor. She won't have to pay $125 each week out of pocket as she does now.

But the new law won't help Kitty Weston(ph) of Minneapolis. For one, it comes too late. Her daughter Anna had anorexia and killed herself nine years ago. When Anna first got sick, Weston figured their Cadillac health plan would take care of the 30 day residential treatment Anna's doctors recommended. But the insurer said it would only pay for a couple of days in the hospital to get her medically stabilized.

Ms. KITTY WESTON: How can this be? I've got this critically ill daughter. I knew that if she had been - let's say that she had had leukemia and it was very serious and that she needed specialized care and she needed to be in a specialized center with the right treatment and the right doctors and the right medication. There would have been no doubt.

SILBERNER: Weston and her husband were going to find the money for the extra care, but Weston says when Anna heard the insurers wouldn't pay, she told her mom that was proof she wasn't sick and refused to stay in the hospital.

There's another reason the new law might not have helped Kitty Weston. The government has yet to release the regulations, so it's not clear they'll be tight enough to make a difference in her daughter's situation. Both advocates and insurers are anxiously awaiting the regulations, given that the law is already in effect. And a few advocates are still disappointed that the bill doesn't list illnesses to be covered and exempts insurance plans offered by smaller business.

Still, Ron Bachman, a mental health advocate in Georgia, says one thing the new federal legislation will do is lessen the stigma against people with mental illnesses.

Mr. RON BACHMAN (Senior Fellow, Center for Health Transformation): The issue of stigma and discrimination is a very important part and message that comes out of this legislation that says, no, we're not going to treat people differently. We're not going to treat their claims differently. We're not going to identify the condition so separately that we treat it and handle it financially differently.

SILBERNER: For mental health advocates, there's always more to work on, like requiring that insurance policies cover mental health and substance abuse in the first place.

Joanne Silberner, NPR News.

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