Insurers often deny coverage for mental health, addiction treatment, report says
Insurers are denying coverage to many Illinois residents for certain mental health services and addiction treatments, according to a new survey of hospitals, psychiatrists and other providers in the state.
Those surveyed said Medicaid managed care organizations, in particular, blocked coverage for a number of services. About 59 percent of providers surveyed said Medicaid managed care organizations “always” or “often” denied coverage for inpatient treatment for addiction and mental health issues during the past year.
Medicaid managed care organizations are insurers that administer benefits for Medicaid — a state and federally funded insurance program for the poor. About 2 million Illinois residents now get coverage through such organizations.
Coverage was better from private insurers, with only 10 percent of providers saying that private insurers “often” denied inpatient treatment for mental health and addiction services over the past year. About 38 percent of providers surveyed said private insurers “sometimes” denied coverage for such treatment.
The report “raises a lot of red flags about potential barriers to coverage,” said Kelly O’Brien, executive director of the Kennedy Forum Illinois, a mental health leadership initiative founded by former Rep. Patrick J. Kennedy.
“If we’re going to address ongoing mental health challenges, in particular the suicide and depression that’s happening and the opioid crisis, ensuring that families have access to coverage … is absolutely critical,” O’Brien said.
The report was released jointly by the Kennedy Forum Illinois, the Illinois Health and Hospital Association and the Illinois Association for Behavioral Health, among others.
State and federal laws require most insurance plans to cover mental health and addiction treatment in a way that’s on par with how they cover other medical needs. But across the country, that’s not always happening, the report says.
The report doesn’t show how coverage of mental health and addition treatment in Illinois compares with coverage of medical treatments, but the data suggests that further investigation is needed, according to the report. It recommends that health plans, insurance regulators and lawmakers do more to ensure compliance with laws requiring comparable coverage of mental health/addiction treatments and medical treatments.
Jennifer Hammer, director of the Illinois Department of Insurance, which regulates private health plans, said in a statement that “Families dealing with mental health issues and substance use disorder deserve support and understanding. Our goal is to ensure consumers learn their rights under state and federal law.”
John Hoffman, a spokesman for the Illinois Department of Healthcare and Family Services, which regulates Medicaid managed care plans, said in a statement the department is working to ensure on-par coverage levels for mental health and addiction treatment and medical conditions.
As part of a current overhaul of Illinois’ Medicaid managed care program, the state will include language in its contracts with insurers addressing the need to cover mental health, addiction treatment and medical conditions comparably, Hoffman said. Medicaid managed care organizations also will be required to prove their compliance with those laws, he said.
However, Jeff Myers, president and CEO of Medicaid Health Plans of America, said the report should be taken with a “big grain of salt.” He doesn’t think Medicaid managed care organizations are denying coverage for mental health and addiction treatment services any more than other insurers. He also criticized the way the data was collected, as part of a self-reported survey.
The report’s authors acknowledged in the report that it’s somewhat limited because the nearly 200 Illinois medical practices and organizations that responded to the survey aren’t necessarily representative of all mental health and addiction treatment professionals across the state.
David Lloyd, policy director for the Kennedy Forum Illinois, called the report a “valuable starting point,” providing “more information than we had before.”
Joanna Dailidas, who recently moved out-of-state after her adult son took his own life, said it’s important insurers provide adequate coverage for mental health services. Dailidas said she and her husband had a lot of trouble getting services covered for their son Joey Dailidas, who died in his Wrigleyville apartment last year at the age of 24.
“My son died fighting a battle that he couldn’t win because he couldn’t get the help he needed,” she said.