Under state and federal law, health insurance companies are required to cover mental health care at the same level they do for physical health conditions. Montana PBS's Anna Rau dug into nationally reported discrepancies in how insurance companies handle physical and mental health claims, and if those discrepancies impact Montanans. She sat down with All Things Considered host Elinor Smith to explain.
Elinor Smith Can you start by explaining what mental health parity laws are supposed to do?
Anna Rau Right. Mental health parity sounds so wonky, but it's really simple. It's basically, insurance companies are required to cover mental health treatments and services the same way that they're required to cover the physical in an insurance plan. So for instance, a health insurance company cannot give you more treatment for something like diabetes or physical therapy and then limit treatments that they provide for mental health. It has to be commensurate on both sides of the plan.
Elinor Smith Could you tell me a little bit about Yvonne Field? How did you first meet, and how are these parity laws impacting her?
Anna Rau Yvonne has an eating disorder, and eating disorders are one of the areas where it seems like patients are really struggling to get the same coverage that you get on the physical side. And they also start out kind of as a physical affliction, and then there's usually a mental health thing underpinning it. And so when the insurance coverage goes from stabilizing the patient physically and the weight physically, all of a sudden, they start talking about, now we need to do the mental health work that's under that. So maybe anxiety, depression, trauma — and suddenly insurance companies become more difficult to deal with, some of them. I'm not saying all of them, and Yvonne has had an eating disorder for decades, and there was an underlying trauma that happened when she was nine that really left her with an unhealthy relationship with food, but Yvonne kind of has run the gamut, and she overexercised. and then would do binge eating. And so she's in a larger body just naturally. And because she's a larger she felt bad about her body, would over exercise, be restrictive with what she eats and developed this really bad eating disorder and has been getting treatment for it for about the last two and a half, three years.
Elinor Smith What was her experience in trying to navigate the root issue of that eating disorder and the mental health treatment after being physically stabilized and receiving that urgent care she needed?
Anna Rau Okay, so with eating disorders, there's different levels of care. There's inpatient intensive, there is outpatient intensive and there's kind of maintenance care and they call them like steps. And so each time she'd move down a step, it seemed like she got a certain amount of insurance coverage for therapy and for nutrition. And then they'd say, okay, you're cut off. You've had 10. That's good. You don't need any more. Despite her medical providers at the Eating Disorder Center in Bozeman saying she needs more counseling. She's just gonna relapse into these eating disorder behaviors again and then cycle back into higher levels of care, which are more expensive for the insurance company.
In Yvonne's case, the Eating Disorder Center is doing the appeals for her because they find it so damaging for a patient to stop care while they are working on these appeals. And Yvoonne talks about that. And if you're also somebody who struggles to believe that you deserve care, That kind of message coming from an insurance company is really hard.
And this isn't just eating disorders. We're talking all of these different, and depression and anxiety, to have an insurance company deny something, and then you have to jump through these hoops to get the care; That's really hard on these patients. And the idea of, is it being denied more often than physical care? Are they requiring more of mental health patients on these plans than they are of physical? because if they are, that would be against the law.
Elinor Smith And I know through your reporting, you spoke to the Montana Commissioner of Securities Insurance, the Bureau Chief of the Insurance Claims Office specifically. What did they end up saying about this dynamic?
Anna Rau What they told me was on the federal level and the state level investigations of insurance companies can be very difficult because it's hard to prove parity. If they limit something on the physical side, they can limit it on the mental health side. It just has to be equitable. So it's hard to know exactly if insurance companies are avoiding coverage or not meeting mental health parity. It can be proven and people can do these investigations, but they need people who can drill down into the data. and then basically say, hey, they're requiring pre-authorizations this frequently on mental health and they're acquiring it this frequently on physical, and then they can compare the two. They can do a comparative analysis, what they call it. So on the federal level, they have done that and they found many problems. And on the state level, nobody is doing that.
Everybody I've talked to since I started this story, almost every person, either they had an interesting problem or they believe this might be a problem for them, or they know somebody who was getting mental health treatment and felt like a denial was unfair. So again, to know if that's true, to know that this is really a violation of mental health parity, the first thing they should do is call the Commissioner of Securities and Insurance, file a complaint, they'll do the investigating, they have teeth.
This episode of Montana PBS Impact first aired April 10 on Montana PBS. You can watch it here.
