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Many Ohio insurance plans now must treat seven illnesses just like other medical ailments
By Cheryl Powell Beacon Journal medical writer
Published on Monday, Oct 22, 2007
Health insurance plans in Ohio now need to treat mental illnesses the same as any other medical problem.
At least for some patients with some conditions.
A state law that went into effect this month requires many but not all insurers to provide the same coverage for seven serious, ''biologically based'' mental illnesses as they provide for physical problems.
The mental health parity law is a long-sought victory for behavioral health experts and patient advocates, who have argued for more than a decade that mental illnesses shouldn't be covered differently than other ailments.
''It does help break down the stigma of viewing mental health conditions as being something apart from other physical ailments,'' said Jim Mauro, executive director of NAMI Ohio, the state affiliate of the National Alliance on Mental Illness.
Many insurance plans limited hospital days for mental illnesses or placed a low dollar cap on the behavioral health services a patient could receive, said Dr. Todd Ivan, president of the Ohio Psychiatric Physicians Association.
Before the law, Ivan dealt with plans that would pay for only $20,000 worth of behavioral health services but as much as $1 million for other medical care.
The new law ''should improve quality of life,'' said Ivan, director of consultation-liaison psychiatry at Akron's Summa Health System. ''When people get treatment, they recover.''
Insurance plans should be notifying enrollees about changes to comply with the new parity law, said Mary Jo Hudson, director of the Ohio Department of Insurance.
''If they are limiting the hospitalization for a biologically based mental illness to three days but they don't limit the same for an appendectomy, then they need to change their policy terms,'' Hudson said. ''All things being equal, a mental health provider should not be treated any differently in their plan than any other medical provider.''
But the mental health parity rule doesn't apply to everyone.
The state law governs fully insured employers, or those companies that pay a monthly premium and then have their insurer pay claims.
The rule doesn't apply to self-insured businesses, or those larger, private employers that pay for their employees' health-care bills. (Self-insured insurance plans are governed by federal laws.)
Federal lawmakers are considering adopting similar mental health parity requirements on a national level.
If that happens, larger self-insured employers also would have to cover mental illnesses the same as other medical ailments.
''We really need federal legislation to cover all employees,'' Ivan said.
The insurance industry generally opposes laws that mandate which services must be covered.
''We have philosophical concerns about any mandate that is imposed by the government,'' said Kelly McGivern, president and chief executive of the Ohio Association of Health Plans.
''We just think consumers and employers who purchase health-care coverage are in the best position to make decisions about what coverage they want to purchase,'' she said.
At this point, McGivern said, it's unknown how much the new parity law will increase overall health-care premiums.
''We're going to provide whatever the government is going to tell us we have to provide,'' she said. ''It's really the consumers who are going to have to pay for those costs.''
The state's mental health parity law is limited to seven specific types of mental illnesses: schizophrenia, schizoaffective disorder, major depressive disorder, bipolar disorder, paranoia and other psychotic disorders, obsessive-compulsive disorder and panic disorder.
Other mental illnesses, milder forms of depression, substance abuse and chemical dependency aren't included in the law.
Overall, about 20 percent of people have some form of mental health problem, Mauro said.
''You really have to take a holistic approach if you want to get people into recovery,'' he said.
If people have questions about whether a mental health service is covered under the new parity law, they should first check with their insurance plan, Hudson said. And if they disagree with the answer, they can then contact the Ohio Department of Insurance for help.
''Don't just assume it's covered because of parity,'' Hudson said.
Cheryl Powell can be reached at 330-996-3902 or chpowell@thebeaconjournal.com.
Health insurance plans in Ohio now need to treat mental illnesses the same as any other medical problem.
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