The Maryland Parity Project works to educate insured Marylanders of their rights in accessing mental health and substance use disorder treatment under The Mental Health Parity and Addiction Equity Act of 2008.
The Federal Parity Law gives many insured individuals easier and more affordable access to behavioral health care. Individuals covered by this law should have fewer barriers in accessing behavioral health care.
The project has two main goals:
- Educating consumers and providers of their rights under the parity law
- Offering case assistance to those whose rights may have been violated
2015 MHAMD Report Finds That Insurance Hurdles Leave Many Marylanders without Access to Needed Psychiatric Services
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The report, Access to Psychiatrists in 2014 Qualified Health Plans, written by The Maryland Parity Project, details the difficulties Marylanders encounter when they attempt to contact psychiatrists or make an appointment. MHAMD performed this study to assess the accuracy and adequacy of the psychiatric networks of commercial insurers. The 2014 Qualified Health Plans (QHP) sold through the Maryland Health Connection were chosen for analysis because they are the only network listings that are public. Researchers spent six months attempting to contact psychiatrists to determine their availability and whether they were taking new patients.
Researchers found that only 43 percent of listed psychiatrists were reachable, with many out of date phone numbers or addresses. More than 10 percent of providers who could be reached indicated that they were not even psychiatrists. Many of the doctors contacted had extremely long wait times. Only one in seven psychiatrists were accepting new patients and available for an appointment within 45 days.
“Picking up the phone to get help is hard enough,” said Adrienne Ellis, Director Maryland Parity Project, MHAMD. “We must ensure that Marylanders who take that first step in seeking care don’t get discouraged before they get the help they need. As the number of newly insured Marylanders continues to grow, wait times will increase and individuals may forgo care or be forced to pay high out of pocket costs to access critical care outside their insurance network.” The report shows that consumers may spend hours on the phone trying to find a provider who is taking appointments and accepts their insurance.
“Between recent cuts to reimbursement rates for behavioral health providers in the public system and the inability to secure a timely psychiatric appointment in the commercial market, doors seem to be closing for Marylanders asking for help,” said Linda Raines, CEO, MHAMD. “Prior studies dating back to 1988 have documented similar access problems for commercially insured individuals in need of care. The situation can no longer be ignored.”
The report’s findings detail the struggles Marylanders face when seeking psychiatric care, including:
- Only 14 percent of the 1,154 psychiatrists listed in the QHP networks were accepting new patients and available for an appointment within 45 days.
- 57 percent of the 1,154 psychiatrists were unreachable – many because of nonworking numbers or because the doctor no longer practiced at the listed location.
- If consumers could not get a timely appointment with an in-network doctor, they would be subjected to high out-of-pocket costs to see an out-of-network psychiatrist.
Download the Full Report: Access to Psychiatrists in 2014 Qualified Health Plans
60 Minutes Report Highlights Heart-Breaking Challenges In Obtaining Treatment for Mental Health Care — Many Maryland Families Could Face Similar Risk if Insurance Regulators Don’t Step in to Help
BALTIMORE, MD (December 17, 2014) — A report that aired on “60 Minutes” Sunday night shared the stories of three families who faced insurmountable barriers erected by a private health insurer to get their children the critical mental health care they needed. Unfortunately, the struggles faced by these families continue even with a monumental law in place since 2008 that was supposed to address years of discrimination by insurance companies.
Known as the Mental Health Parity and Addiction Equity Act, the law requires equality between insurance coverage for medical/surgical treatment and mental health/substance abuse treatment. Despite the legislation, residents of Maryland find themselves having difficulty getting coverage for treatment for behavioral health conditions and it’s the Maryland Insurance Administration (MIA) that needs to step in to protect these consumers.
“The federal law requires insurers to demonstrate that standards for approving or denying care is the same for mental health as for any other medical issue. Without this information, which insurers have been reticent to provide, complaints cannot be resolved quickly when care is denied, and lives hang in the balance as the bureaucratic process wanes on,” said Linda J. Raines, chief executive officer of the Mental Health Association of Maryland. “As the 60 Minutes report illustrated, there are life or death consequences when parents have nowhere to turn in their battle to get the care their children need. We need the Maryland Insurance Administration to be proactive in ensuring Maryland families are able to access the care Congress sought to protect when the Federal Parity Law was passed six years ago.”
The Maryland Parity Project of the Mental Health Association of Maryland has answered almost 200 calls and helped many families who had experiences similar to those shared by Scott Pelley in the 60 Minutes report. In some cases, resolution of complaints through the federal appeals processes has dragged on for two years or longer, leaving families with no access to care, which is why it is so important for state regulators to take action.
“Unfortunately, it’s a complaint-driven process and families who call us during a crisis are focused on getting their child the care they need and don’t have time to battle with the insurance company bureaucracy,” said Adrienne Ellis, Director of the Maryland Parity Project. Also, stigma about behavioral health is a real deterrent to filing a complaint or going public, she said.
“One of the first questions people ask when they consider filing a complaint is: will there be a big red flag next to my name with the insurer? People are worried that if they complain, then all of their treatment will be denied or their employer who provides their insurance coverage may find out,” Ellis said. Because this happens with so many denials, many violations go unnoticed or unenforced.
Accordingly, stakeholders in Maryland, including the Mental Health Association of Maryland, are focused on addressing the problem of barriers and persistent insurer discrimination and will propose legislation in Annapolis during the 2015 legislative session that will better equip the Maryland Insurance Administration to proactively assure that insurers are fully compliant with the law.
“Regulators in other states have issued strong parity enforcement regulations and filed legal briefs on behalf of individuals whose care has been denied by insurers,” said Raines. “There is huge economic impact for states when commercial insurers fail to provide care, as the state ultimately ends up footing the bill for care that is provided when individual situations rise to a crisis level.”
This legislation would put the onus for parity on the insurance companies as they hold all the information necessary to determine compliance, and are required by the federal law to conduct an internal parity analysis. Currently, the lack of transparency by insurance companies makes it impossible for families to file a complete appeal or complaint without legal assistance, which can be costly.
The Maryland Parity Project is an initiative of the Mental Health Association of Maryland. The project educates consumers and providers of their rights afforded by MHPAEA and provides case assistance to those who feel they are not receiving the benefits to which they are entitled or feel they have been discriminated against by their insurer.
The Mental Health Association of Maryland (MHAMD) is the state’s only volunteer, nonprofit citizen’s organization that brings together consumers, families, professionals, advocates and concerned citizens for unified action in all aspects of mental health and mental illness. MHAMD envisions a just, humane and healthy society in which all people are accorded respect, dignity and the opportunity to achieve their full potential free from stigma and prejudice.
Visit www.MarylandParity.org for more information.
For a PDF version of this release, use this link.