Mon | Feb 6, 2023

Health insurers scorn coverage for psychiatric care

Published:Sunday | May 20, 2012 | 12:00 AM

Insurance Helpline, With Cedric Stephens

Question: My daughter was recently diagnosed with a mental illness. As a result, she is now being treated by a psychiatrist. The costs of her doctor's visits plus medication are very expensive. Our health plan pays only a fraction of the charges. The benefits that are provided for physical illnesses are, on the whole, more adequate. Are there any good reasons for what seems to be a bias against persons like our daughter with mental illnesses?

- SB, Kingston 8.

HELPLINE: The World Wide Web, according to my favourite search engine, has nearly 4.3 million bits of information on the topic you raised. The data appeared in response to my enquiry: "Is there a bias against the mentally ill?"

I also learned from my research, from an American Psychology Association publication, that even some professionals — professors with doctorates in psychology no less — discriminate against the mentally ill.

When the search about bias was narrowed to insurance companies, 2.8 million items were listed.

One, a BBC News report published in October 1999, said that "people with a history of mental illness are facing unfair discrimination from insurance companies". This was the conclusion of a study conducted by a mental health charity called Mind.

The UK study appeared seven months after an article headlined 'Health insurers biased against mental illnesses' was published in The Financial Gleaner.

Denied for mental-health problems

Mind said it was "surprised to find that many people were denied insurance or had exemptions placed on them because they have a history of mental-health problems even in cases where 20 years had passed since they had a problem."

The findings of the Internet research and the short review of history shows the scale of the problem your family faces and illustrates that bias is not limited to insurers in Jamaica.

Fast-forward 13 years. The New York insurance regulator recently fined 15 insurers US$2.7 million to enforce that state's Mental Health Coverage Law. Insurers had failed to "notify small businesses that they were eligible to buy special coverage for mental illnesses and children with serious emotional disturbances. The law states that insurers must give small employers the option of purchasing extended mental-health benefits when they buy or renew their basic health-insurance plans".

In 2003, our Government set up a National Health Fund. One of its aims is to provide individual benefits to assist "persons, initially, to purchase specific prescription drugs used in the treatment and management of designated chronic illnesses".

Three of the 15 specific conditions for which NHF provides assistance include diseases of the central nervous system, namely "epilepsy, major depression and psychosis".

Information was sought from the market leader to see how they handled the issue of mental illnesses in contrast to those that affected the body, since I researched the subject 13 years ago.

The company's vice-president of group insurance services wrote: "I am going to err on the side of caution and provide you with an outline (instead of the specimen copy of the contract that was requested) of how our contracts handle 'Mental & Nervous Disorders'.

"The contract defines 'Mental & Nervous Disorders' as follows: Neurosis, psychoneurosis, psychopathy, psychosis, or mental or emotional disease or disorder of any kind.

"The actual benefits payable vary from one benefit schedule to another and from one client to another depending on the requirement of each client. Some benefit schedules allow payments to be made like any other diagnosis - $X per office visit; $Y per day for room & board. Other benefit schedules have assigned specific limits to the treatment of mental & nervous disorders - for example, a maximum of three specialist consultations, 17 office visits, 10 days in-hospital per annum."

This information — as the company official knows — is useless. I have no way of comparing how the stated benefits for mental and nervous disasters compare with those for physical illnesses based on the information that was furnished.

My next stop at the employee benefits manager of a leading broker turned out to be another waste of time. He seemed to believe that it was okay for health insurers to treat mental-health illnesses differently from illnesses that affect the body.

only two companies

The approach of our small health-insurance market — only two companies — towards mental health issues appears not to have changed much since the end of the last century.

The maximum benefit for psychiatric care is limited to a maximum of 24 visits per policy year. The first four visits will be paid at one rate while the other 20 will be reimbursed at a lower rate.

In contrast, there are no such limits for non-specialist and specialist physicians for physical illnesses. Several actuarial studies in the United States have shown that parity in benefits between physical and mental illnesses will not lead to increases in the price of insurance.

My guess is that with less than 20 per cent of the population having access to health insurance, this item though very important to you, is no, big thing to the insurers and the Ministry of Finance and Planning.

The ministry with responsibility for health has led the way in the design of the benefits for some mental illnesses in the NHF.

Private-sector health-insurance providers should follow their lead and move into the 21st century.

Cedric E. Stephens provides independent information and free advice about the management of risks and insurance.aegis@cwjamaica.comSMS/text message to 812-7233