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(USA) Parity on board for MI Tx?

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“Health plans have long supported the Mental Health Parity and Addiction Act and have worked to implement these requirements in a manner that is affordable, safe, and effective for patients,” said Karen Ignagni, president and chief executive officer of America’s Health Insurance Plans, a lobby that includes Aetna AET +1.26% (AET), Cigna CI +1.77% (CI), Humana (HUM) and UnitedHealth Group (UNH) as members. “We appreciate that the final rule enables patients with mental and behavioral health conditions to continue to benefit from the innovative programs and services health plans have pioneered.”


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Mental Health Parity has been part of the Ten Essential Benefits for a long time.  It is not actually new news and yet this week

Kathleen Sibelius is talking about it as if it is new.  I think the administration (for good reason) is trying to accentuate something



Anyway, every single policy that I am reviewing, recommending, selling, for 2014 (and 2013 frankly) has Mental Health Parity.

Albeit if you purchase a bronze plan there will be a HUGE deductible before the MH parity kicks in.


Anyway, this is a wonderful thing for all of us.  Any one suffering from a serious MI will benefit greatly - to the extent

that I believe it will save lives.


It is not surprising that Aetna, Cigna, Humana, and UHC lobby together. Though my experience with them over the years

is .....well.....they are sort of the axis of evil.  I much prefer local Blues - run in individual states.  Much more responsive

to have a carrier with a headquarters where you could actually drive there and make your complaint in person.

The Blues headquartered in individual states are part of the community, do a lot of corporate donations and charity work.

And they are not for profit.  


Anyway, I digress.  It is good that you posted this to remind everyone of Mental Health Parity.

Edited by bpladybug
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I too was wondering why they were talking about this again. As I recall, that law went into effect several years ago. Although, the part about not needing to go through any more steps for MI/rehab as for other appointments/hospital stays/rehab does have me curious. Why am I still having to go through a second company to get rehab approved? I don't have to do that for anything else. When I had surgery, the doctor said I needed it and off I went. When my kid needed to go IP, we had to jump through hoops to make it happen and it had to be pre-approved by another company--not BCBS. Why am I jumping through these hoops if there is parity? Can anyone explain? I'd be grateful.  

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Because the way the law was originally written, there were loopholes that allowed either some policies or some states, I forget which, to have exemptions. Affordable Care Act changes that by closing the loopholes.






About one-third of those who are currently covered in the individual market have no coverage for substance use disorder services and nearly 20 percent have no coverage for mental health services, including outpatient therapy visits and inpatient crisis intervention and stabilization.[3]  In addition, even when individual market plans provide these benefits, the federal parity law does not apply to these plans to ensure that coverage for mental health and substance use disorder services is generally comparable to coverage for medical and surgical care. 
In the small group market, coverage of mental health and substance use disorder treatment is more common than in the individual market.   We estimate that about 95 percent of those with small group market coverage have substance abuse and mental health benefits.[4]  Again, the federal parity law does not apply to small group plans.  In many states, state parity laws offer those covered in this market some parity protection, but most state parity laws are narrower than the federal parity requirement. 


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Because I have no income while I wait for Ssdi, I only qualified for medi-cal (CA's version of Medicaid.

I am concerned that it won't cover Rozerem which is the only thing that can get me to sleep. It won't be generic until 2017.

I also take pro vigil to stay awake during the day. It is generic but still expensive.

If they don't cover them, paying a discounted price for a silver plan would probably be cheaper.

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