Miriam Carey tried to ram her way into the White House and was shot and killed after leading police on a high-speed chase through the heart of Washington, D.C. We later learned that she was suffering from post-partum depression.
A former Navy reservist, who happened to have a security clearance that granted him access to the Navy Yard in Washington, D.C. gunned down 13 people at work. Turns out there was substantial evidence he suffered from some type of mental illness and in fact had reached out to a VA Hospital for help. That help never came and he was shot and killed during the incident.
These are sensational stories that make the news. Unfortunately, there are tens of thousands of Americans every day who grapple with mental health issues and who are not getting treatment. Why they're not getting treatment is a complicated issue. However, one critical component has long been how mental health has traditionally been covered under insurance plans. Lack of insurance and the high cost of care are the biggest reasons mental-health patients don't seek treatment, according to a study released in this month's Health Affairs.
While some plans make provisions for mental health and substance abuse illnesses, the coverage can be very limiting. According to the Department of Health and Human Services (HHS), nearly 20 percent have no coverage for mental health cases, even for outpatient therapy visits or inpatient crisis intervention and stabilization. That leaves far too many people vulnerable to what can be catastrophic consequences of not receiving the proper treatment.
What Will the Affordable Care Act Change?
According to an HHS report, the full roll out of the Affordable Care Act (ACA) or "ObamaCare" will provide first-time access to mental-health services for roughly 32.1 million Americans. One of the most important components under the ACA is that coverage for behavioral-health services must be generally comparable to coverage for medical and surgical care. That represents a fundamental shift in how insurance plans cover these conditions. For so long, mental and behavioral health conditions were treated as secondary conditions which resulted in subpar coverage and care.
- The ACA also requires that non-grandfathered health plans (those that were not in existence on March 23, 2010) cover a core package of healthcare services known as Essential Health Benefits that fall under 10 categories. One of those categories is mental health services and addiction treatment. This requires inpatient and outpatientcare be provided to evaluate, diagnose and treat a mental health condition or substance abuse disorder.
- Another category calls for preventive services which will cover among other treatments, alcohol-misuse screening and counseling, depression screening for adults and for adolescents, domestic- and interpersonal-violence screening for women, and behavioral assessments for children. Under the preventive services category, if you receive treatment from an in network provider, you cannot be charged a co-pay even if you haven't met your yearly deductible.
- Further, Starting Jan. 1, 2014, you can’t be denied for preexisting conditions, including mental illness and plans can’t limit how much they pay for your lifetime medical expenses.
The Healthcare Exchanges opened on October 1st and you can visit healthcare.gov to sign up for coverage if you are uninsured or not satisfied with your employer's coverage.
The media has reported that there have been many glitches on the website with people trying to create accounts and sign up for coverage. There is a phone number you can call to sign up as well. Unfortunately these glitches have not been fixed as of yet but they are looking to be repaired soon. If you are one of the millions that suffer from these conditions or know someone who is, the ACA has provided the largest expansions of coverage in a generation. Hopefully you will now have the opportunity to get the care you need and deserve.
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