Northern Lakes CMHA works to ensure coverage parity for behavioral health

If insurance covers inpatient treatment for a medical issue, parity means inpatient care for a mental health issue is covered, as well.

Navigating the world of health insurance can be tricky — from determining whether or not certain services are covered by a plan or if a provider is available in the area to simply figuring out how exactly to pay for everything. Finding and receiving care isn’t always a straight shot. The same goes for behavioral health care. Sometimes, finding care or assistance for mental health or substance use struggles can be even more difficult.

That’s where behavioral health parity comes in. Parity means if an insurance provider covers behavioral health care or substance use care, access and coverage to those services must be similar to the access provided to physical health care. According to the Behavioral Health Parity Action Team at the Community Health Innovation Regions of Northern Michigan (CHIR), “federal law requires most health insurance plans to provide parity in coverage, but not all do.” 

Northern Lakes Community Mental Health Authority (Northern Lakes CMHA) board member Dave Freedman has been working with the Parity Action Team at Northern Michigan CHIR to educate patients and providers. According to Freedman and resources provided by CHIR, patients can report a lack of parity first to their insurance provider, and if their concerns are not addressed, the complaint can be taken to Michigan’s Department of Insurance and Financial Services. Freedman and the team at Northern Michigan CHIR agree that complaints like these are “one way to force health plans to be accountable to parity laws,” and can also lead to improvements in coverage overall.

Parity makes behavioral health care more accessible.

In a recent conversation with MI Mental Health, Freedman shared what parity is and what to do when a patient experiences a lack of it.

Q. What should the average person know about behavioral health parity?

A. Parity says that if you have substance use/mental health coverage, it should be covered at the same level as your medical coverage. All ACA plans have behavioral health coverage with the exception of Medicare, but the “equal amount” is determined by the individual plan.

Dave FreedmanQ. What could a lack of parity look like for someone? What should someone do if they experience a lack of parity? 

A. One example is if someone’s insurance company says they only provide outpatient treatment for behavioral health, but inpatient treatment is provided for physical health conditions. Another is if the condition, whether it be a behavioral health condition or one related to substance abuse, is considered “not severe enough” to receive treatment. Right now, if you think you have parity and you see that your rights are not being upheld, there are ways to submit complaints — that’s your only recourse right now, outside of hiring a lawyer. 

While existing parity laws apply to things like individual health plans, insurance provided through a company, or Medicaid, not all plans are covered. This means that it is completely legal for some insurance providers to restrict visits to behavioral health services, require authorization for behavioral health services, or deny services altogether when they are deemed not medically necessary.

Q. What are some common issues or roadblocks that people face when searching for behavioral health care or health care providers?

A. The first thing people assume is that they don’t have coverage for behavioral health. There are challenges following up on things regarding health insurance, like if you’ve ever been blocked on your own health care insurance, that amplifies that experience. There are also the geographic challenges. If the only provider in your network is four hours away and you don’t have transportation or access to telehealth, the options seem very limited. There also just aren't enough providers in Northern Michigan. It can sometimes be difficult to find care at all.

If passed, Michigan HB-4707 will help enforce health parity.

Q. How is it determined whether or not a behavioral health care service is medically essential?

A. There are a number of levels you may be at with a physical condition, and the same goes for behavioral health and substance use. It’s very dependent on the insurance company.

Q. What is currently being done to keep people aware of their rights and to keep behavioral health care accessible?

A. We will now be working on supporting HB-4707 which is the state legislation for parity enforcement. Education is coming down from [Northern Michigan ] CHIR to Northern Lakes CMHA as well as other locations across the state. 

HB-4707, if passed, will amend the state of Michigan’s current parity laws to standardize what can be deemed medically necessary when it comes to insurance companies covering behavioral health and substance use services, ultimately making those services more accessible. While the Parity Action Team at [Northern Michigan] CHIR is hard at work fighting for this amendment, patients can make a difference themselves by submitting complaints when they experience a lack of parity.

For more information on parity and the work of the Action Team, contact the team at behavioralhealth@northernmichiganchir.org or visit michirlearning.org.

Rylee Barnsdale is a Michigan native and longtime Washtenaw County resident. She wants to use her journalistic experience from her time at Eastern Michigan University writing for the Eastern Echo to tell the stories of Washtenaw County residents that need to be heard.

Photos courtesy Northern Lakes Community Mental Health Authority and Pexels.com.

The MI Mental Health series highlights the opportunities that Michigan's children, teens, and adults of all ages have to find the mental health help they need, when and where they need it. It is made possible with funding from the Community Mental Health Association of Michigan, Center for Health and Research Transformation, Genesee Health System, Mental Health Foundation of West Michigan, North Country CMH, Northern Lakes CMH Authority, OnPoint, Sanilac County CMH, St. Clair County CMH, Summit Pointe, and Washtenaw County CMH.