Suicide-related benefit exclusions may be illegal

Some health plans exclude benefit payment for healthcare costs stemming from suicide-related injuries, though experts say these exclusions aren't allowable in many cases under federal law, according to Kaiser Health News.

Just as payers may deny payment for injuries caused by high-risk pursuits such as skydiving, health insurance subscriber contracts may contain "source-of-injury" exclusions for services provided to treat self-inflicted harms. Examples include head injuries or broken bones following attempted suicide.

"Suicide is a common exclusion," Sara Rosenbaum, a health policy professor at George Washington University, told KHN. "Insurers are all over the place on this, and state law varies tremendously."

Yet mental health advocates and government experts question the legality of these exclusions. Citing HIPAA rules prohibiting discrimination against members, experts told KHN source-of-injury exclusions aren't allowed when claims result from a medical condition.

"A plan may not exclude coverage for self-inflicted injuries (or injuries resulted from attempted suicide) if the individual's injuries are otherwise covered by the plan and if the injuries are the result of a medical condition (such as depression)," HIPAA nondiscrimination rules state.

The rules apply to all employer-based health insurance plans and affect the individual market, including marketplace products offered pursuant to the Affordable Care Act.

The mental health parity law prohibits insurers from restricting mental health and substance abuse benefits more than their medical and surgical counterparts, FierceHealthPayer reported. But if insurers deny claims payment after attempted or actual suicide, it's probably not a parity issue since it doesn't involve prescription drugs or therapy services covered by parity requirements, a U.S. Department of Labor representative told KHN.

America's Health Insurance Plans said the issue hasn't raised major concerns within the health insurance industry, KHN noted.       

For more:
- read the Kaiser Health News article
- check out the HIPAA nondiscrimination rules

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