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The feds take a closer look at mental healthcare coverage

Kaiser Health News’ April 30 story explores how some insurers are using the pandemic as an excuse to make parity a rarity.

To set the stage, let’s look at how things were before the pandemic. A recent report by the Government Accountability Office (GAO) paints a picture of a behavioral health system that was already extremely strapped pre-COVID-19. On top of the strained system, patients who managed to access treatment often had trouble getting their insurers to pay for it.

Then the pandemic hit, created an overwhelming increase in the demand for mental health services. In early 2019, an average of one in 10 adults reported anxiety or depression symptoms. But during the pandemic, those numbers went up to an average of four out of 10. And compared with the same period in 2019, there were 36% more emergency room visits for drug overdoses and 26% more visits for suicide attempts during the first seven months of the pandemic. At the same time, therapists and other behavioral healthcare providers became even less available, with many organizations being forced to lay off employees, reduce hours, and even close programs.

Why are these providers in financial trouble? Those that were interviewed by the GAO cited reimbursement issues—in other words, they were having trouble getting paid by insurers.

The GAO’s report casts doubt as to whether insurers have been consistently abiding by federal law regarding parity in insurance coverage. This law forbids insurers to pass along more of the bill for mental health care to patients than they would for physical care. When it’s not followed, patients find themselves responsible for fees they hadn’t anticipated and potentially can’t afford.

The GAO investigation was requested by Oregon Senator Ron Wyden, who chairs the Senate Finance Committee, as a response to his constituents’ complaints that their insurance claims were being denied. We applaud this effort, and we’ll be watching closely to see how insurers respond.

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