National Nurses United

Mental Parity_Temp 11/24/09 6:53 PM Page 13 "This is all about what insurers think is a financial burden. This LISA HANEY/IMAGES.COM/CORBIS is about whether they think they'll be left holding the bag, and some insurers will drop coverage. They'll invoke protective tactics, like saying that mental healthcare is not part of their health plan but part of an EAP ." in fourth grade, but doesn't consider that the onset of his disorder. Instead, it wasn't until he was 19 that he started having delusions and manic episodes that led to a misdiagnosis of schizoaffective disorder at age 25. The diagnosis and subsequent treatment caused him to become more sick, creating hallucinations he didn't have before. He changed medications and functioned fine for a while , until he began having panic attacks that left him debilitated and unable to work. Finally, six years ago, he received what seems to be the corr ect diagnosis: bipolar 1 with attention deficit hyperactivity disorder and generalized anxiety disorder. All this time, he was on health insurance: First through his job at a big-box home improvement store, then through the Americorps/ Vista program, and now through Medicare. But because the laws don't require, for instance, that health plans cover name brand medications that sometimes have different therapeutic windows than the generics, patients are sometimes required to "fail out" of less e xpensive medications before they are given the medications that work for them. That happened to Corbin earlier this year. His health plan changed the formulary it used to cover prescription medications and so the medication that had been working well for him changed. "I'm not even positive that it's really working because I have rapid-cycling bipolar and I've been cycling a lot lately," he said. "Also, they don't cover some of my medications, so I pay $150 out of pocket every month for them. I've got to have that medication and so I've got to do whatever I've got to do to get m y medications. I'll go without a lot of other things to have it just so I can stay stable." OCTOBER 2009 And there are other limits: on the number of psy chiatric visits he can have, and a limit on the number of prescriptions covered. So will the new mental health parity law help Corbin? Probably not. Since he's now on Medicare, the new law doesn't apply to him. It also doesn't apply to people on individual plans, employers with fewer than 50 employees, many Medicaid enrollees without a Medicaid managed health plan, or federal employees. It only applies to group plans and large companies that self-insure their employees. And even then, the law lets insurers out of the law if mental health services increase their healthcare costs by more than 2 percent the first year and 1 percent in subsequent years. Finally, the federal parity law doesn't even mandate that insurers provide mental health coverage at all. It only requires that if an insurance plan chooses to include mental health benefits, it must charge the same for premiums and copays and can't limit mental health serv ices if it doesn't limit physical health services. That raises a big red flag for Randy Revelle, senior vice president of policy and public affairs at the W ashington State Hospital Association. Revelle, who was diagnosed with bipolar disorder in the 1970s, has a personal stake in Washington's state mental health parity law and worked with the association to sign on as supporters. Decades ago, he couldn't be admitted to the hospital for mental health tr eatment because his plan didn't cover it—even though he was becoming more and more delusional and a threat to his family. When he finally was admitted, it was under the guise of a herniated disk. Since then, he has been an intense advocate for mental health parity. W W W. C A L N U R S E S . O R G REGISTERED NURSE 13

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