Too many health plans and insurance carriers are putting mental health coverage behind physical health conditions even as the pandemic puts mental health problems in hard focus, according to a Tuesday report from the federal government.
The health care coverage rules that group health plans and insurance carriers apply to physical and mental health conditions are supposed to be on the same footing.
In other words, when it comes to mental health, coverage specifics such as co-pays and prior authorization requirements cannot be more stringent than the prevailing financial rules and treatment limits that apply to medical and surgical benefits.
But coverage imbalances that can make mental health services harder to access and more expensive are still happening, said a report from the Department of Labor, Health and Human Services and the Treasury Department.
For example, the report cited an unidentified health plan that excluded methadone and naltrexone as a treatment for substance use disorder. Two other health plans used the same insurance company, which covered nutritional counseling for conditions like diabetes, but not for anorexia, bulimia and binge eating. Three other plans excluded a therapy for autism that could prove valuable for patients.
After federal authorities dug into the discrepancies, changes were made, the report said. The results from a range of inquiries include 26 health plans and issuers that said they were going to make changes to their plans or already made the alterations.
The “findings clearly indicate that health plans and insurance companies are falling short of providing parity in mental health and substance-use disorder benefits, at a time when those benefits are needed like never before,” Labor Department Secretary Marty Walsh said in a statement.
Walsh has been open about his recovery from alcoholism. “As a person in recovery, I know firsthand how important access to mental health and substance-use disorder treatment is. Enforcement of this law is a top priority for the Department of Labor and an objective I take personally,” he said in his Tuesday statement.
The bi-annual report is one requirement of the Mental Health Parity and Addiction Equity Act of 2008. The $900 billion stimulus bill that lawmakers passed in December 2020 authorized measures including a second round of stimulus checks, and it also armed federal agencies with more enforcement tools related to the 2008 law on parity between physical and mental health.
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Alongside the pandemic’s physical health risks, the last two years have posed mental health risks, including burnout at work and addiction. More than 100,000 people died from drug overdoses in the 12-month period ending in April 2021, according to the U.S. Centers for Disease Control and Prevention. That’s an almost 30% year-over-year increase.
Mental health problems are a workplace issue, too. Depression leads to 200 million lost work days in America at a cost of $17 billion to $44 billion, according to the CDC.
The new federal report shows the shortfalls on mental health treatment, but it’s not the only place spotting the gaps.
Employers say mental health is a top priority for 2022
The vast majority (86%) of employers said addressing their staff’s mental health concerns, stress and burnout is a top goal for 2022, according to a new survey from WTW
the human resources consulting company previously called Willis Towers Watson.
Nevertheless, 49% of the poll respondents haven’t formally pulled together their strategy, while 25% have already presented and adopted strategies to improve their workforce’s well-being.
Monday’s survey polled more than 300 employers who had a combined 5.3 million workers in their ranks.
In a tight labor market, companies may try turning their employee well-being programs addressing mental, physical and financial health into something that hooks and keeps staff, said Regina Ihrke, senior director, health and benefits at WTW.
“For years, employers have used financial rewards to encourage employees to take action for their own well-being; however, as those incentives have often failed to change employee behavior, employers are seeking new avenues to engage and incent employees to take charge of their own well-being,” she said.