Multiple Sclerosis, Mental Health, and Insurance

  • We know that Shock, Anger, Denial are common reactions to a diagnosis of multiple sclerosis.  And we know that depression can be caused by the disease process itself.

    So when it’s time to seek professional help from a psychologist, certified social worker, psychiatric nurse, or psychiatrist, how does your insurance policy cover your mental health benefits?

    Does your insurance require higher copays for mental health visits as compared to physical health?  Does it limit the number of visits which are covered during the year?  Do you have to pay a percentage of the charge rather than a set copay?

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    Congress has been trying to address the inequality of mental health benefits for over a decade and it is now included in the “Wall Street Bailout Bill” of all places.  The Senate voted Wednesday in favor of the Emergency Economic Stabilization Act of 2008 and it’s up to the House to pass the same bill so the President can sign it into law.

    Since the Bailout Bill could very well be the last piece of legislation passed by Congress this season, it includes a few housecleaning extras.  One of those extras is the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008

    This Act would improve the mental health insurance coverage for policy holders in group plans, but would not affect policy holders of individual plans or medicare.  Also included in the legislation is a small business exemption for companies with fewer than 50 employees, as well as a cost exemption for all businesses. 

    The new Mental Health Parity Act does not mandate that group plans provide mental health coverage.  It does, however, require that group insurance policies which do offer mental health coverage cannot impose separate financial requirements or treatment limitations as compared to medical surgical coverage.  Basically, mental health must be treated in the same manner as physical health.  The legislation developed in talks with mental health, insurance and business organizations to craft compromise legislation. 

    The 1996 parity law, authored by Pete Domenici and Paul Wellstone, provided parity for annual and lifetime limits between mental health coverage and medical surgical coverage.  The new legislation expands parity by including deductibles, co-payments, out-of-pocket expenses, coinsurance, covered hospital days, and covered out-patient visits.  It also requires that if in-network and out-of-network benefits are offered for medical surgical coverage, they must also be offered for mental health coverage.

    So what does this have to do with multiple sclerosis?

    Well, when you seek psychiatric expertise and/or talk therapy counseling services to address depression and the emotional aspects of MS, you will be covered the same as for other types of doctors’ visits.

    Unfortunately this Act only applies to folks who have group coverage, are employed by a business with more than 50 employees.  But it’s a great start!!

     

    Lisa Emrich is author of the blog Brass and Ivory: Life with MS and RA and founder of the Carnival of MS Bloggers.

Published On: October 03, 2008