Sunday, July 16, 2000

New laws expand mental coverage




The Associated Press

        LOUISVILLE — Molly Clouse says two laws that went into effect Friday that expand insurance coverage for mental-health care and substance-abuse treatment for some Kentuckians may aid recovery.

        Ms. Clouse, who has been treated for bipolar disorder, said the laws passed by the 2000 General Assembly should make treatment easier to get. Ms. Clouse testified in support of the mental-health parity legislation.

        The former teacher from Louisville said limited insurance coverage for mental health meant that she could not receive hospital care for as long as her doctors said she needed it two years ago.

        The laws will require independent review when health-care companies refuse to pay for a medical procedure.

        Neither law applies to self-insured companies that use their own money to pay health-insurance claims, and the mental-health parity law exempts companies with fewer than 50 employees.

        A third law passed by the General Assembly that also will have an impact on health-care coverage sets up a fund so people with high medical bills can get insurance through the state, starting in January.

        Traditionally, insurance companies have provided less coverage for mental health than physical health. For example, policies often set caps of $50,000 to $100,000, and treatment might be restricted to five days in the hospital and 10 outpatient visits for mental illness or substance abuse every six months — limitations not imposed for physical health problems.

        The new law does not require covered companies to offer mental-health coverage. But now, whenever policies are renewed or issued, mental-health coverage — if included — must equal coverage for physical problems. For example, if a co-payment is $10 at a doctor's office for arthritis treatment, the co-payment amount will be $10 for treatment of depression.

        Ms. Clouse said her only worry was that some employers might decide not to offer mental-health coverage out of fear that their health-insurance costs could increase.

        But that's a shortsighted view, Ms. Clouse said. When mental-health problems go untreated, she said, “the illness can come out sideways” and manifest itself as a more serious physical problem.

        Sheila Schuster, executive director of the Kentucky Psychological Association who worked for passage of the measure, said mental-health coverage can reduce absenteeism and has not caused appreciable cost increases elsewhere.

        State Rep. Bob Damron, D-Nicholasville, who sponsored the legislation, said that in most states with similar laws, costs have not increased because prompt treatment of mental illness has prevented long-term problems and reduced overall health-insurance expenditures.

        But Melodie Doom-Shrader, executive director of the Kentucky Association of Health Plans, whose members insure about 1.3 million people, said she believes that premiums may increase and that some companies may decide against covering mental-health care.

        “This is a noble piece of legislation,” she said, “but the public needs to know that it will drive costs up.”

        The statute applies to about 600,000 of the state's 2.2 million insured people, said Janie Miller, deputy commissioner of health insurance.

        People who work for state government and many of those employed by some large companies already have been getting roughly equal coverage for mental and physical health, Ms. Miller said, so their premium costs should not increase much.

       



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