Many of the nearly 300 people who will die today from drug overdoses and suicides, have private insurance plans that failed them. Someone from your family, social group, place of worship, or workplace could very easily fall victim to our broken system.
A powerful report by Milliman confirms insurers are not adhering to the Mental Health Parity and Addiction Equity Act of 2008 (The Federal Parity Law), which requires them to treat illnesses of the brain, such as depression and addiction, the same way they treat illnesses of the body, such as diabetes and cancer.
The alarming report found reimbursement rates for mental health and substance use disorder treatment providers, through private insurance plans, were far lower than reimbursement rates for other medical providers, relative to Medicare rates.
It also revealed inpatient mental health and substance use disorder treatment occurs in an out-of-network setting four times more often than inpatient medical care, and outpatient mental health and substance use disorder care is more than five times as likely to be out-of-network than outpatient medical care.
In New Hampshire, a state with one of the highest drug overdose rates, inpatient mental health and substance use disorder treatment was 10 times more likely to be out-of-network.
What does this mean to the average person? You better have a lot of time and money if you want to get mental health or addiction treatment for yourself or a family member. When insurance plans do not reimburse providers adequately, many choose not to participate in the plans’ networks.
So, when someone makes a decision to seek help — yet they are unable to find a provider in network who doesn’t have a six-month wait or require a two-hour drive each way — they often have to go out-of-network, resulting in higher costs. Many people give up because they can’t afford treatment or find providers. In what other situation would we stand by as a nation and let this happen?
The President’s Commission on Combating Drug Addiction and the Opioid Crisis, on which I served, contained two straightforward recommendations regarding the Federal Parity Law:
- Congress should provide the Department of Labor with greater enforcement authority.
- All federal and state regulatory agencies responsible for enforcing parity should use a standardized tool when performing audits of health plans.
What does this mean to the average person? It means accountability.
The U.S. Department of Labor (DOL) is responsible for parity enforcement for employer-sponsored health plans in America, but currently, it does not have the capacity to provide regulatory oversight. And about those audits — if health plans and insurers do not face real consequences for violating the law, they are less likely to comply.
So where do we go from here? On Dec. 5, I testified before the Senate Appropriations Committee where I asked the Subcommittee on Labor, Health and Human Services, Education, and Related Agencies to appropriate an additional $17 million annually to the DOL for increased enforcement capacity.
The Kennedy Forum, in collaboration with the American Psychiatric Association and the Parity Implementation Coalition, has already created an audit tool that is being implemented in several states.
State insurance commissioners have enforcement authority over the Federal Parity Law for some health plans, and many of those commissioners received federal grant money to increase parity enforcement efforts. As more states secure funding, they would be wise to be in touch with the experts who created the tool.
So, what can you do? To those who are struggling to help loved ones: fight back.
Make your voice heard. Provide details of your insurance denial on Parity Registry. You can also learn to file an appeal with your health plan, send a complaint directly to state enforcement officials, and more.
Educate yourself on what your state is doing. Track legislative, regulatory, and legal parity activities for all 50 states and at the federal level on Parity Track.
To those who haven’t yet been personally impacted by this crisis imagine how it would feel to lose a child because you couldn’t get them the help they needed. Support politicians who actually walk the walk for parity.
And to the person out there who is suffering in silence: You are not alone, and you have nothing to be ashamed of. Thousands of us are fighting for you every day. And until you are ready to share your story, we will be your voice.
Patrick Kennedy, former U.S. Representative (D-R.I.), is the founder of The Kennedy Forum, a member of the President’s Commission on Combating Drug Addiction and the Opioid Crisis, co-founder of One Mind, and author of the New York Times bestseller “A Common Struggle: A Personal Journey Through the Past and Future of Mental Illness and Addiction.”