The Hazelden Blog

by Helen Taws, Hazelden Director of Public Advocacy

On October 3, 2008, after more than a decade of hard work, the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 was passed by the United States Congress. The purpose of the act was to ensure that the treatment for mental health problems and addiction to alcohol and other drugs would be covered by insurance companies in the same way treatment for other diseases is covered.  In that moment there was much to celebrate.  The bill was enacted into federal law one year later on October 3, 2009.  Since 2008, the energy generated by celebrating the successful passage of the bill has been redirected toward developing a final draft of regulations so the “law” will be implemented according to original intent, and the expectation is that at that time the insurance companies will be accountable if they fail to comply.

YES, there has been progress!  More people are speaking out about their experience with recovery either their own or their involvement as a friend or family member. Many share their stories of success with treatment for addiction to alcohol and other drugs and these are powerful messages that reach legislators at the state and federal levels. Progress is readily visible the increased number of people that do speak out, thus decreased evidence of stigma attached to mental health and addiction and expanding access to treatment services through increased public funding and private health care coverage.

As a result of the new federal law, there could be changes to in insurance plans right now! However, there are exceptions such as companies with 50 or fewer employees are exempt and the law also offers the option to to “opt out” by not mandating coverage for mental health and substance use disorders. The good news is that we have not seen companies flock to this knee jerk reaction and this indicates a greater understanding of the disease and willingness to stay in the game. Until we have regulations for implementation, it will be difficult to hold insurance companies accountable for a law without a regulatory structure by which it can be enforced.

Now is the time to find out how parity will affect your coverage.  Here’s what you can do

1. Call your insurance company and ask if your 2010 plan includes coverage for mental health and substance abuse services.
2. If your plan does cover these services, ask for a printed copy of the information that details your annual and lifetime limits, copayments, coinsurance requirements, deductibles, out-of-pocket expenses, levels of care covered, and coverage limits. Out-of-network does not necessarily mean not covered. Many plans will cover some portion of care and this also could depend upon out-of-pocket expenses. Ask for a printed copy that outlines the coverage for medical and surgical services to see if the coverage is consistent with the coverage for mental health and substance abuse services.
3. If the coverage for mental health and substance abuse services does not seem comparable with the coverage for medical and surgical services, contact your employer’s benefits administrator or HR director and ask about the disparity. One thing to remember is that there are exemptions for companies with 50 or fewer employees so it’s possible that your insurance plan will not be affected.
4. If you or a family member are in need of mental health or substance abuse services and are having trouble determining your level of coverage for treatment, ask the treatment center or medical facility if a case manager or patient advocate is available to help you navigate the process.

Hazelden developed expertise and leadership in the field of addiction through 60 years of experience and continues to demonstrate leadership toward expanding access for treatment of mental illness and addiction through the Center for Public Advocacy. We know that with treatment and management of these progressive illnesses, people can and do live full and productive lives.  If left untreated, the progression of the illness can be fatal.

January 2010