US (Washington Insider Magazine) – After placing the Build Back Better on hold, Democrats have turned their attention to an issue that rests on the hearts of millions of Americans; preventing insurers from denying mental health and substance addiction claims. This bipartisan issue aims to make affording treatment for both mental and addiction struggles possible.
Although this is not a new issue, Congress attempts to stop Insurers’ disparage of policyholders has not prevented health insurers from violating laws and refusing to pay for mental health and substance abuse services. Of course, not everyone is on board. The majority of the insurance industry and its allies are gearing up to fight back by sending letters to stop lawmakers from passing the two bills.
COVID-19 has made state and federal lawmakers increasingly aware of the importance of affordable and attainable mental health resources. Alongside record high opioid overdoses, emergency room visits and rises in eating disorders have raised many red flags on this bipartisan issue. Both the House and Senate have drafted a comprehensive bill that enforces insurers to create mental health parity. Two hearings will be held by the House and Senate Committee where Surgeon General Vivek Murthy will give a testimony.
Per Senator John Cornyn, mental health is finding a renewed focus among this year’s senatorial candidates. He was quoted stating that mental health is a very vital part of our overall health. If there are existing laws that do require parity to enforce, there may be underlying issues delaying the enforcement.
Under the law, insurers aren’t allowed to charge higher copays, offer selective coverage, or flat out deny claims for mental and addiction care more than they do any other medical procedure or service.
Still, federal investigators have found many instances where this is occurring often and many insurers are not being held accountable because the regulators do not have the resources or tools to pursue the appropriate course of action. To avoid this issue, some states have instilled more strict parity laws to enforce insurers to do right by policyholders seeking mental health and addiction claims.
While most are in favor of holding insurances responsible for their role in the mental health and addiction crisis, others have outwardly mentioned their dissatisfaction.
James Gelfand, the executive vice president of public affairs at the ERISA Industry Committee, was found complaining, stating that it appears that insurers are making profit upon profit whereas doctors may be going out of business based on their action and framework.
Some disputers of the bill have claimed it’s unfair to blame insurers because they believe once the bill is passed mental health care providers will hike up their rates, forcing insurers to pick up the tab.
David Lloyd, a policy advisor at the Kennedy Gorum studying mental health coverage and parity, said, “This deterrent effect and ensuring people can get the care they need when they need it is really critical because, otherwise, it’s kind of a whack-a-mole situation where it becomes very difficult to police.
Despite the pushback from the insurance industry and its allies, the passing of the pair of bills looks promising.
