About 25 percent of plans sold on health insurance exchanges violate a federal mental health parity law that requires insurers to offer equal benefits to physical and mental healthcare, according to a new study published in the journal Psychiatric Services.
In particular, there were two problems with the exchange plans--wide cost differences for physical and mental health services and more stringent requirements for prior authorizations for patients to receive mental services.
"These disparities are prohibited under the law, but they do appear in plan brochures--and not in isolated instances," study leader Colleen Barry, an associate professor at the Johns Hopkins Bloomberg School of Public Health, said in a statement. "It suggests there's a need to better regulate what is being offered to potential enrollees. More monitoring is critical."
The study authors reached those conclusions after reviewing benefit brochures from insurers participating in two robust state exchanges--one in a large state and one in a small state (the study didn't name either state)--during the first open enrollment period.
Barry said she's concerned that insurers are actually trying to steer members away from buying plans with better mental health coverage because those services are usually more expensive than general insurance.
In response to the study, America's Health Insurance Plans said it's unfair to claim that insurers exclude mental health benefits based solely on information consumers see before they buy a plan. "It's nearly impossible to say a plan is not in compliance if you are just looking at the summary of benefits and coverage," AHIP Spokeswoman Clare Krusing told the Courier-Journal/USA Today. "You have to look at the claims history to make sure it's at parity."
What's more, Cigna CEO David Cordani said physical health benefits often extend to some aspects of mental health. For example, most antidepressants are prescribed by primary care doctors. "Disconnecting the mind and the body, which is the way historically insurance wanted this, doesn't make any sense," he told the Courier-Journal.
Last year, 60 Minutes found that insurers are denying mental health claims for patients who need long-term mental healthcare, FierceHealthPayer previously reported.