Monday, August 17, 2015

What happened to Parity? Dewar Insurance discriminates against people with mental health disorders.


A colleague wrote into our psychiatric society's Listserv --  his son is starting college and he was solicited to purchase tuition reimbursement insurance in case something goes wrong and his son needs to withdraw.  He was surprised to read that the company offered one amount if a student withdraws for 'medical' reasons and another, lesser percentage, if the student withdraws for 'mental health' reasons.  Oh, and the medical leave needs a doctor's note, while a mental health leave requires that the student must have been hospitalized for two consecutive days for the psychiatric condition.  

That seemed outrageous, and it occurred to me that I have a kid in college and I had the same offer for tuition reimbursement insurance sitting in my spam.  Only my offspring is at a different university in a different state and there is no medical vs. mental health differentiation for her large university.  I clicked on a few schools and concluded this was a quirk of my colleague's son's institution.  He was quick to point out that I was wrong -- colleges and universities are all over the map with this, and I soon realized that every school that offers this policy in Maryland has some inequity for mental health reasons-- either a lesser amount of reimbursement or a requirement for hospitalization.  I don't quite understand -- are they saying that mental illnesses are less real or valid so you have to 'prove' you're really sick, and by the way, you get less of a refund?  Disability of all varieties has the potential to be an individual matter especially when it involves pain or fatigue.  And in Maryland, our governor has set the bar quite high -- he was recently diagnosed with an aggressive form of lymphoma and is undergoing chemotherapy -- certainly a good reason to take some time off -- but his photo (minus hair) is in the paper every day with his declaration about some topic or other.  At some level, a doctor of any specialty is left to trust the patient (or not) when he says he just can't do something because he's in too much pain, too tired, too depressed, or his preoccupation with delusions and hallucinations is getting in the way.  

The company mentioned is Dewar -- you can look up a university they cover here: College Tuition Refund - Home Page, but apparently it's been an issue for years.  Below I'll post some articles about the issue from The  New York Times and Psych Central.  It's disheartening that despite this outcry and confrontation in 2011, Dewar continues to have these discriminatory policies.  I couldn't find anything that indicated that NAMI or APA were part of the conversation, but I could well have missed it (~please let me know if I have).  In the comments section on the third article, one person noted that when she complained to Yale's president, then the policy did change to one of equal coverage, but it seems like a war of many small battles which are mostly not being fought.  In addition, I'm posting a link to an excellent summary about why parity legislation has not resulted in the changes that were hoped for.  

On Psych Central:
And more in the NYTimes (read the comments)

And, finally, for anyone interested in an overview of how and why parity is failing, this is an excellent summary, from earlier this month:
Congress tried to fix mental health care in 2008. Lawsuits charge it isn't working.

And, no, I don't want to talk about why the background is green.  Where is Roy when I need him?



ILuvCats said...

Just don't buy the insurance. It's optional. Long term disability insurance discrimination is a much larger issue than tuition reimbursement insurance. 2 year limit for mental illnesses, usually. If you can't recover from mental illness sufficient to work full time, you are destined for a life of poverty unless your spouse has a good job.

clairesmum said...

Recent move to California from New England. Now have Anthem BC - and our policy limits reimbursement for outpatient MH visits to 30 visits/year (roughly every other week, with 4 'extra' visits). Presumably that covers psychotherapy every other week and med visit every 3 months. As is often the case, most private practitioners are 'out of network.' Our reimbursement was 16% of the cost of each session. But the real kicker to the idea of parity (and to the pocketbook) is that none of the money that is spent on outpatient mental health care can be applied to the maximum out of pocket costs!
Our insurance comes via my husband's job, we chose the expensive plan to preserve freedom of choice (we have a couple of key meds that do not have generic equivalents). California allows premiums to be adjusted based on the age of the insured persons and we are both in the last age band before Medicare.
Until now I never worried about having to go without necessary medical or mental health care when we needed I do.

Joel Hassman, MD said...

The three of you have all these contacts among providers in various facets of our profession, I would be very interested if you would ask what your peers think about this demand of us to provide 90 day supplies of medication to psychiatric patients, especially early on in treatment.

Why do I ask this here? Because this is one time they, as in insurers, claim parity for mental health with somatic care, and still the agenda is to be disruptive to mental health outcomes at the end of the day.

The bias and discrimination is pervasive, and the silence by most providers is deafening as complicit!

Just my imperfect opinion...

Lisa said...

Yeah, I don't know.

Disclaimer - I took time off from college after severe depressive episode and hospitalization. I went to a private school with loans I'll be paying back for the rest of my life and didn't have insurance like that. You're not taking into account that you're speaking from the perspective of a highly comfortable married parent of a child in college. That doesn't take into account most people.

I don't actually find the policy discriminatory and I'm an individual who had to take time off from school without any insurance payback. Mental illness such as depression doesn't really have clear clinical guidelines for something like disability. It's incredibly subjective. Frankly, depression isn't the same thing. Until there are clearer guidelines for what is and is not incapacitating and does require intensive medical and psychotherapeutic treatment and time away from work/school, I don't see a problem with lesser reimbursement for an illness that is not really defined. Are all these people you're so upset about identifying themselves to their ADA offices and disability offices on campus, utilizing the same services anyone with a "physical" illness would? Nope, but suddenly at the end of term when it's been all parties and floating up until grades are due, people need to withdraw for a mysterious, vague "depression" -- that didn't require much if any treatment until that point..... yep. You find it stigmatizing but it's stigmatizing for a reason. Too many people take advantage. There should be a clear indication that there was a need for withdrawal/time off --- perhaps consistent decline in work, attendance at classes, evidence of some form of outpatient treatment that didn't work (of course confidentiality protected), etc. A psychiatrist or therapist simply saying after one meeting "s/he needs time off" isn't acceptable and shouldn't qualify for special insurance. Medical proof is required for people with physical illnesses. Why should "mental illnesses" be any different? You're asking for special treatment for privileged upper class students. But you often do that on this site, because it's your blog.

mobile said...

Maybe all it means is that the asymmetric information problem is larger for mental health.

T said...

"are they saying that mental illnesses are less real or valid so you have to 'prove' you're really sick" -- yes, and with reason. people don't fake cancer. nobody should get tens of thousands of dollars back because they felt a little sad. Tuition reimbursement should absolutely necessitate proof beyond a one time meeting with a therapist who says joey feels sad and needs to take time off and have all his (parents') money refunded.

That's not reality.

Anonymous said...

I think it's discriminatory. There shouldn't be a separate standard for physical and mental illness. I was making straight A's in graduate school until I got sick. I stopped going, and because I didn't withdraw my A's eventually turned to F's. I was in and out of the hospital. There may be people who fake mental illness for some kind of gain, but there truly are people who become so ill they can't function and who stop leaving their house. When I got better my psychiatrist wrote a letter and thankfully I was able to salvage my graduate degree. I didn't have any kind of insurance, so I lost money on the classes I had to repeat.


T said...

P-K -- you would have lost the same money if you were "physically ill" instead of "mentally ill" because you didn't have insurance. If you were so ill you couldn't leave your house, and were in and out of the hospital, obviously there would be documentation to support that and IF YOU HAD insurance, it would have covered it. You didn't lose money because you were mentally ill, you lost money on the courses because you didn't have insurance. Had you had that insurance, the documentation provided for severe mental illness would have sufficed for you to make a claim. That's not discriminatory at all. It sucks that you lost money but that happens to thousands of people every year for both physical and mental health reasons.

Sideways Shrink said...

I think all of these comments and Dinah's original post all make sense. However, I am unclear whether there is any legislation in the ACA or elsewhere at the federal level that would cover THIS kind of insurance. The ACA deals with health insurance, which regulates non-grandfathered health insurance plans. Are other kinds of insurance regulated per mental health parity? If someone gets into multiple car accidents due to mental health reasons their insurance rates still change or their coverage is canceled the same as if they are just terrible or unlucky drivers.
Does anyone know the answer to my uncertainty re: parity and health insurance vs. other kinds of insurance?