Mental Health Parity in The Workplace
Defining Mental Health Parity
Mental health parity addresses fairness when it comes to seeking help and obtaining quality care. To combat the longstanding issue of unequal health coverage for mental and physical care, the federal government initiated legislation to protect individuals requiring treatment for mental health or substance use disorder. By ending these discriminatory practices in insurance plans, we are able to ensure that everyone has access to necessary healthcare regardless of their condition.
How does Mental Health Parity Impact the Workplace?
It’s become increasingly obvious that failing to provide employees with access to proper mental health care can be a costly mistake for employers. This is why guaranteeing quick, efficient, and inexpensive treatment options for people battling depression or anxiety has become one of business’s main priorities today. By providing these services, employers are not only looking out for their workforce but also safeguarding their own long-term interests.
Companies recognize that preventing prejudice in benefit coverage is not only ethical but also an essential business need due to the money lost from untreated mental health issues. These can negatively affect work performance and productivity, healthcare costs, employee retention rates, and disability claims.
Employees report their struggles with a number of issues regarding receiving healthcare, including:
- Finding mental health providers that are within their insurance network
- Prolonged waiting periods for appointments
- Outdated and onerous utilization review criteria that often result in coverage rejections
- The overwhelming financial burden of out-of-pocket costs for medical care
Not only can mental health conditions such as depression and anxiety cause immense distress, but they also incur a range of work-related costs.
Here are some to be aware of:
- Depression and anxiety cause a yearly economic burden of up to $1 trillion worldwide due to loss of productivity.
- Research illustrates that depression leads to 200 million lost workdays annually in the US, costing employers between $17 and $44 billion.
- Statistics show a startling 20% of American adults, 51.5 million individuals, battle with mental health issues. However, only 44.8%, or less than half, received the necessary aid and assistance they required to tackle their conditions.
- The emergence of presenteeism, in which employees show up to work but are unable to be fully engaged due to psychological health issues, is an alarming trend that can put a strain on any organization.
- When a mental health issue occurs with other chronic illnesses, the treatment expenses for the primary condition can rise by two or three times!
Tips for Employers on Mental Health Parity Compliance
Regulatory agencies at both the federal and state level are intensifying their enforcement of mental health parity laws in response to a continuing failure to comply. This has created unforeseen ramifications for employers.
At the end of 2020, Congress declared a new and improved Mental Health Parity and Addiction Equity Act (MHPAEA) with additional provisions that mandate employer health plans and insurers to carry out comparative analyses in order to comply with non-quantitative treatment limits. This was included in their Consolidated Appropriations Act (CAA). These MHPAEA measures will give individuals access to mental health benefits as well as substance abuse treatments without having qualitative limitations imposed on them.
The federal parity legislation necessitates that the US Department of Labor (DOL) continuously review and analyze comparative analyses for compliance purposes. To assist employers in following these requirements, DOL recently released a modernized online self-compliance tool to provide clear guidance on how to ensure adherence to federal parity law regulations.
To lessen the likelihood of risk and meet mental health parity compliance, insurers and issuers should assess their health plan delivery in good faith. The Department of Labor issued guidance that those who have diligently applied the self-compliance tool are likely to fulfill the CAA’s criteria for comparative analysis. Therefore, it is imperative for them to consider non-quantifiable treatment limitations (NQTLs) in order to comply with standards set forth by governing bodies.
As the Department of Labor reviews comparative analyses submitted by employer health plans and insurers, these are some pertinent issues to consider:
- The prior authorization necessary for inpatient mental health services received at both providers within the network as well as outside of it
- Establishing criteria for provider acceptance within a health plan and determining reimbursement rates
- The usual, customary, and reasonable charge methods that determine the reimbursement rates of providers who don’t participate in a given insurance network
Fair Insurance Coverage
In order to better protect their rights, it is critical that individuals understand the violations prohibited by the Mental Health Parity and Addiction Equity Act (MHPAEA). The federal law explicitly states that insurers are not allowed to discriminate against those with mental illnesses or substance abuse disorders. By becoming knowledgeable of what constitutes a violation under MHPAEA, patients will be able to more confidently advocate for themselves should they experience any form of discrimination.
- You are entitled to the care your physician has advised is necessary for any mental health or substance use disorder you are facing. Your health plan cannot make it a requirement that you first try less expensive treatments before obtaining coverage if they do not demand the same “fail first” policy when treating illnesses with other coverages provided within your plan.
- Except for a few exclusions, your mental health co-payment or coinsurance should not exceed that of any other form of medical care. Additionally, you should have one single deductible and out-of-pocket maximum to encompass all your healthcare needs.
- When visiting a psychiatrist for both medication management and psychotherapy on the same day, you should only be required to pay one co-payment.
- You deserve to find a mental health professional “in network” who is qualified and experienced in treating your particular condition as well as one that you can get to easily from home, within an acceptable timeframe.
- Unless your health plan typically necessitates pre-authorization for the majority of medical care, mental health visits or therapies should not require approval.
- The number of visits and hospital days should not be restricted unless the same limitations apply to other medical conditions covered by your plan.
- Your health insurance should cover you even if you do not complete the prescribed treatment or a prior recommended course of therapy.
- Your health plan must provide you with a comprehensive written explanation about their review of your treatment necessity, the justification for rejecting your claim, and proof that the plan is adhering to federal law.
- You have the right to dispute your plan’s decision regarding your care or coverage. You can file an appeal with either your plan or a separate review organization that is independent of both you and them.
- If your health plan offers out-of-network benefits and you see an out-of-network psychiatrist, your health insurer should reimburse a portion of the amount paid for that visit. This could be illegal if the reimbursement is noticeably less than what other doctors are receiving who are also outside of their network. Find out how much physicians get reimbursed by checking the explanation of medical and surgical benefits supplied to you by your insurance provider.
If a health plan or issuer fails to meet the requirements of parity laws, the DOL will take corrective action and request that they rectify the violation. Moreover, this information will be communicated with all enrollees as well as states where the group health plan is located or where the insurer has business operations. In addition, the DOL shall issue an annual report detailing any non-compliant plans and issuers to Congress and make it publicly available for review.
Moreover, State Insurance Commissioners are closely scrutinizing health plans to ensure they follow mental health parity laws. The CAA has given states the power to request comparative investigations and obligates insurers to make them accessible when requested.
Employers have a strong incentive to collaborate more closely with health plans and third-party administrators in order to guarantee mental health parity compliance throughout the long term. It’s essential to share these points about the law and steps for a violation within your company, as they are simple yet comprehensive. Ensure that everyone is aware of this important information.
Norwood, NJ 07648
The Union Workforce Initiative is for educational, training, and awareness purposes only. This is not an Employee Assistance Program. We help build awareness within the workforces of employer/employee assistance professionals, substance abuse professionals, nurses, doctors, and other educational professionals.