What is “IOP” anyway?
In the past, health insurance coverage of treatment for mental illness was much different than coverage for physical conditions. Mental health care coverage had its own structure when it came to cost-sharing, was much more restrictive, had different pre-authorizations requirements, and even had different caps when it came to annual and lifetime coverage. Needless to say, finding a plan with generous mental health benefits was near impossible.
In 1996, Congress passed the Mental Health Parity Act (MHPA), which prohibited large employer-sponsored group health plans from imposing higher annual or lifetime dollar limits on mental health care than on medical or surgical care. While this was a needed step toward coequality, there were still a lot of holes in the act and insurers were able to loop-hole their way out of many of the mandates. States followed the MHPA by passing their own mental health parity laws, some trying to fill in the gaps of the ‘96 act.
Then, in 2008, Congress passed another act, the Mental Health Parity and Addiction Equity Act (MHPAEA). This historic stride was motivated by both the public and legislators, encouraging greater acceptance for mental illness. The new act was created to cover the holes left by the previous act and to include application for substance abuse treatment. And, the Affordable Care Act (ACA)went further by “mandating coverage rather than requiring parity only if coverage is provided.”
The ACA amended the MHPAEA to apply to individual health insurance coverage (and not just group health plans and group health insurance coverage). The Affordable Care Act even “defined coverage of mental health and substance use treatment as one of the ten essential health benefits.” Meaning, all plans must cover
- “Behavioral health treatment, such as psychotherapy and counseling
- “Mental and behavioral health inpatient services
- “Substance use disorder (commonly known as substance abuse) treatment.”
However, even with all the progress that has been made on this issue, mental health care is still outlandishly unaffordable. Questions must be addressed like,
- “Will employers and consumers know their rights and responsibilities under the law?
- “Will health plans and insurers follow the law and pay for behavioral health services equal to those routinely covered for other conditions?
- “Will federal and state regulators monitor and enforce compliance with the law?
- “How will state and federal courts interpret the law as questions about its implementation come before them?”
Unfortunately, “health insurers face little enforcement of federal mental health parity law,” and, “even with insurance parity rules, counseling may count as specialty care.”
As you can see, while the U.S. has made progress toward making access to mental health care more affordable, there are still miles to go. Get involved in your local and state governments. Make MHPAEA compliance a high-priority item to your state’s insurance commissioners.
And, lastly, if you’re worried if you’ll be able to afford our mental health care services, please don’t hesitate to call 385-313-0055. One of our administrative staff members can discuss payment options with you so you can get the care you need.
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