A child comes into the emergency department, gasping for air. She is immediately seen by an emergency doctor, diagnosed with an asthma attack, and started on treatment. Knowing that she will need a hospital admission, her doctor calls her insurance company to try to convince them that the admission is medically necessary. If the insurance company disagrees, they will deny her hospital care and her family will have no choice but to take her home, untreated.
After 40 minutes on the phone, the emergency room doctor finally gets through to the appropriate person. The person on the other end of the line, a semi-retired physician with no experience in treating children, listens as the emergency room doctor presents the case and why it would be dangerous for her to go home. The girl’s family paces the halls. They anxiously await; will she get the help she needs or not?
If this sounds like something that could not possibly happen in pediatric emergency departments across the United States: rest assured, that’s because it’s not. Not if your child is suffering from asthma. However, if your child suffers from a mental or behavioral health disorder, the scene above is very much the reality. In fact, despite legislation passed in 2019 to ensure that mental and physical health are treated equally by insurance companies, the public has no way of knowing if this legislation is being adhered to. We can only learn that by demanding a public hearing that would hold insurers accountable.
Here’s why parents should be concerned:
- Great disparities remain in authorizations for medical care and mental health care: If your child needs to be hospitalized to treat a medical condition, an approval by insurance is not required. But, people suffering from a mental health crisis require insurance authorization before they are allowed inpatient care. This is only one of the many ways in which insurance companies treat mental health differently from other illnesses.
- Great disparities remain in reimbursements for medical care and mental health care: An office visit for a mental health concern is 10 times less likely to be covered by a child’s health insurance. Even when the visit is covered, the health care provider makes 42% less for that visit compared to what they would make for a non-mental health concern. Inadequate reimbursement forces many mental health care providers to choose between accepting only out-of-pocket payments and closing their practices altogether. Although 1 in 5 children in the United States suffer from mental or behavioral health disorders, only 20% receive specialized care for those disorders. Given the high out-of-pocket costs for such care and the national shortage of people who provide it, it is easy to see why so many children go without the mental health care they need.
In 2017, a national study found that Connecticut provided inequitable insurance coverage for mental health disorders. To address this disparity, Connecticut legislators passed Public Act 19-159, commonly known as the “Mental Health Parity Act.” This law made it illegal for insurance companies in Connecticut to place more stringent limits on coverage for mental health care than other types of health care. It also required insurance providers to submit annual reports to demonstrate that they complied with this law. The first deadline for submitting these compliance reports was April 2021 and while the law does not require a public hearing to review what the reports contain, it does allow for one. So, if we, the general public, want to know whether insurance companies are complying with regulations, we will have advocate for a hearing and demand access to transparency.
It is easy to imagine that a physical illness like asthma poses a greater risk to children’s health than mental or behavioral health disorders, but this is simply not the case. In 2017, suicide was second only to accidental traumas as the leading cause of death in children over the age of ten. As medical providers have long known, it is impossible to achieve true wellness without addressing mental health.
By passing Public Act 19-159, Connecticut set a standard for ensuring mental health and physical health conditions were treated equally. By holding a public hearing and addressing non-compliance, our lawmakers can show us that they, too, share that belief and are willing to honor the law that enacts it. We need to press our lawmakers to hold this hearing, so insurance companies are held accountable for their actions and so payment parity is transparent.
Margaret S. Blondal MD is from Manchester.