A young woman sits on a couch with her therapist.
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The Biden administration plans to crack down on health insurance plans that discriminate against people who need mental health care and substance abuse treatment.
A proposed rule published Tuesday by the Health and Human Services, Labor and Treasury departments aims to push health insurers to comply with the Mental Health Parity and Addiction Equity Act.
That law, which was passed in 2008, requires insurance plans that cover mental health care and substance abuse treatment to offer the same level of coverage for these services as they do for other illnesses.
White House domestic policy advisor Neera Tanden told reporters in a call Monday that too many insurers are evading the law and making it difficult for patients to access mental health care.
Insurance plans often do not provide enough therapists in network, which forces patients to seek care out of network and pay more. Patients also often have to get permission from their insurer to seek treatment or have their claims denied leaving them with the bill.
“This has meant millions of people who have insurance are paying out of pocket when they shouldn’t have to,” Tanden said.
More than 1 in 5 adults in the U.S., or 58 million people, live with a mental illness, according to the National Institute of Mental Health.
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The proposed rule would require insurance plans to evaluate how their coverage policies impact patients’ access to mental health and substance abuse treatment, Tanden said.
Insurers would be required to take action if they are not in compliance with the law, she said. This could include adding more therapists to the insurance network if patients are seeking care out of network too often, Tanden said.
The proposed rule will undergo a 60-day public comment period before it is finalized.
The health insurance industry’s lobby group AHIP in a statement Tuesday attributed the challenges patients face in accessing mental health care to a shortage of clinicians. Kristine Grow, a spokesperson for AHIP, said the industry has been working to expand access through telehealth, new technologies and integrating mental and physical health.
Grow said AHIP believes that everyone should have access to mental health care that is on par with physical health. AHIP is evaluating the Biden administration’s proposed rule, she said.
A survey published in July of nearly 2,800 patients found that people with insurance face more challenges accessing mental health services than other types of medical care.
Nearly 40% of people enrolled in insurance through their employer had to seek more costly mental health care or substance abuse treatment out of network, according to the survey conducted by the research institute NORC. By comparison, 15% of people seeking physical health care went out of network.
More than 50% of patients reported that their insurance denied coverage three or more times for mental health or substance abuse services, compared with 33% who reported the same for physical health care.
And nearly 60% of those surveyed who sought mental health care or substance abuse treatment did not receive any care in at least one instance.
