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An Open Letter to Insurers About Mental Health Coverage: Does It Really Exist?

I haven’t posted in a while, some things have happened that, while positive, I don’t want to share… yet

The health insurance that I currently have has a separate policy for mental heath issues.  Looking at the insurance website’s list of providers shows all manner of psychologists & psychiatrists to choose from.  Calling their offices though reveals the fact that none of these MHPs (mental health professionals) accept my insurance at their practice.

A little further digging exposes what is really going on:  The hospitals that these MHPs are affiliated with do accept the insurance for inpatient care, so the insurer lists them as accepting their insurance.  Personally, I think that is misleading at best and basically it boils down to the fact that if I need counseling, it is out of pocket.

I can spend Flex dollars on these sessions, but since they are rather expensive, I would quickly go through the dollars that I have budgeted for little things like the insulin I need every day to stay alive.  Next year, I believe, the Flex plans will be capped at $2,500.  I will use all those dollars simply on prescriptions.  All endo, ophthalmologist, PCP visits will be out of pocket.  Eyeglasses and any copays due to illness will be out of pocket.  Nothing like taxing the monies that patients need to spend for their health.  But I digress…

I’ve thought for a long time that any chronic or life-altering illness should include counseling as part of the treatment regimen.  Speaking only about Type 1 diabetes, the amount of stress that is placed upon us is unimaginable to those who don’t “get it”.  If you don’t know whether you “get it” or not, you don’t.

I’ve always been resistant to counseling.  And self-help books always just pissed me off.  But, after 40-odd years of diabetes, I finally decided I was ready.  Actually, that decision was probably a culmination of previous decisions and choices I had made over the last few years, finding the DOC and really just not liking myself very much.

Enough about me, the reality of it is that patients with diabetes (of any type, including caregivers) will have better health outcomes if they are able to mentally navigate the various mental, physical, emotional, financial and social tolls that this condition extracts from us every single day.

Better outcomes? Yes, as in less complications and better quality of life.  It always struck me as fundamentally wrong that insurance companies seemed more than happy to pay for amputations, dialysis, or transplants but not willing to help obtain the things that could have prevented these things in the first place!  I know they are “gambling” that we will not be on their plan when complications do occur.

Mental healthcare is just as important as the physical healthcare we require.  After decades of diabetes, it has become a bigger burden than the diabetes.  That’s why every cent I am spending out-of-pocket is worth it, to obtain what I need with no “net” to help  me.

So here is my question:  Insurers, why is mental health not on par with physical health?  Why is only the body worth treating when the things that make us individuals, make us human are not?

** I’m interested, how many other people have had similar experiences with insurance or have similar policies?  How many have no coverage? How many do?

“This post is my May entry in the DSMA Blog Carnival.  If you’d like to participate too, you can get all of the information at http://diabetessocmed.com/2012/may-dsma-blog-carnival-2/

© 2012 Scott Strange, Strangely Diabetic and http://StrangelyDiabetic.com

  • Yes, flex cards will be capped at $2500 under Obama’s plan (Thanks, Obama! grrr.)  It doesn’t cover much when you have a chronic disease. 

  • Mike Hoskins

    Excellent and thought-provoking post here, Scott. I experienced this a year ago when I first explored getting some mental health help – my insurer at the time wouldn’t cover in much the same way you’ve described. But now I have better coverage. My endo recommended the Behavioral Health folk at the affiliated hospital but they didn’t take my insurance there; so I had to go through their private practices and one did cover it. My co-pay is $35. Actually, my coverage provides for something like 52 sessions a year – seriously, who’s going to use THAT much?? Mind Ninja told me she was skeptical and as probably setting the stage for a future change with much less coverage. Who knows.

  • Erin Carper

    We have a couple of Mental Health Parity acts that were signed into law (one in 1996-ish? and one in 2008 I think) that have leveled the playing field some with regards to benefits for stuff like this, but they really have a long way to go. I think it’s telling that we actually had to sign parity acts into law to get insurance companies to better cover mental health benefits. Insurance companies are pretty good at finding loopholes around these kinds of laws, and while we’ve come a long way in treating mental health like we do physical health, I think we have quite a ways to go still! Thanks for your post! 

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