Mental health parity
- By Milt x_Zall
- Nov 12, 2000
Federal employees in the Federal Employees Health Benefits program will
receive the same coverage for mental health and substance abuse as they
do for other illnesses, starting with the 2001 plan year.
Beginning Jan. 1, coverage for men-tal health, substance abuse, med-ical,
surgical and hospital pro-viders under the program will all have the same
deduc-tibles, co-insurance, and co-pays. At present, FEHB health plans apply
higher patient cost-sharing and shorter day and visit limits to mental health
and substance abuse services than they do to services for physical illness,
injury or disease.
Of course, everyone's premium will go up, but it's unclear what portion
of next year's premium increase is attributable to increased mental health
benefits. Carriers will be allowed to "manage" their health care benefits.
This process can include directing you to a specific provider, requiring
you to get prior authorization from the plan for nonemergency services and
requiring you to follow a treatment regimen authorized by the plan. The
authorization process may require you to call your plan first.
Some health plans will manage your care through managed behavioral health
care organizations (MBHOs) and their provider networks, while others will
manage it through their own provider networks and internal processes. An
MBHO contracts with health plans to provide a range of behavioral health
services to the plan's enrollees. The health plan or its MBHO will typically
review a provider's prescribed services to make sure that they follow standard
practice and are appropriate.
Choice of providers depends on your health plan. All fee-for-service
plans, preferred provider organizations and some point-of-service options
offer coverage for providers outside the health plan's network for mental
health and substance abuse services. Health maintenance organizations usually
limit benefits coverage to providers participating in their networks.
I have mixed feelings about this development. I think people with mental
health problems should receive the same level of service as those with other
ailments. How-ever, people with mental illnesses are apt to be sensitive
about discussing their problems, and managed mental health care requires
they divulge lots of personal information about their illness in order to
get proper care. I'm afraid people with mental illnesses will not receive
proper care because they will resist efforts to find out more about their
On the other end of the spectrum are people who like to talk with a
shrink. They're not really ill and shouldn't be entitled to benefits. But
I bet you a nickel that their psychiatrists will certify that they are ill.
Where does this leave us? Sounds like another well- intentioned government
program that wasn't thought out very carefully.
—Zall is a retired federal employee who since 1987 has written the Bureaucratus
column for Federal Computer Week. He can be reached at email@example.com.