But what most Georgia residents need to know is the so-called “parity” provision, says Kaleb McMichen, spokesman for President David Ralston, who was the legislation’s primary sponsor. This part of the law states that insurance companies cover mental health services in the same way as physical care services. Drug and substance abuse treatment should also be treated the same as physical care.
Here’s an example of how it should work: Suppose a person enrolled in an insurance plan has an unlimited number of doctor visits for a chronic condition like diabetes. Then, by law, that plan must also offer unlimited visits for a mental health condition like depression or obsessive-compulsive disorder.
Getting into the weeds of the new law
The new law came into force on July 1. From this date, insurance companies must cover “medically necessary” care. But it’s important to stress that this is nothing new, says Roland Behm, board member of the Georgia Chapter of the American Foundation for Suicide Prevention.
National legislation already requires most health insurance schemes to treat mental health and addiction in the same way as other medical care. But many companies are finding ways to circumvent the law.
This new law in Georgia gives a definition of what is “medically necessary” to include “generally accepted standards for mental health or addiction care,” so there is no gray area.
The new law gives insurance companies far less leeway to arbitrarily deny mental health coverage. The new law favors the judgment of the mental health professional treating the patient.
If an insurance company seeks to deny mental health coverage, the denial should be based on standards generally recognized by mental health professionals, not guidelines developed by or on behalf of the insurance company. .
How can a person ensure that their mental health condition is treated the same as a physical condition?
The biggest change that insured Georgians should expect now is that insurance companies offer many more mental health and addiction professionals. But it could take some time, and Georgia residents may have to file complaints with the state to spur change.
There will be several “very common red flags” indicating that an insurance company is not following this new law, says Eve Byrd, director of the Carter Center’s mental health program. They include, but are not limited to the following:
– A person cannot find a mental health clinician who is “in-network”, i.e. when an insurance company pays for the treatment.
– The number of treatments or visits for mental health or addiction services is limited in a way that other health care visits are not.
– A person must call and get permission to have their mental health care covered, but they don’t have to for other types of health care.
Are there loopholes or ways that insurers will try to deny this treatment Georgia residents should seek?
Byrd of The Carter Center said care must be taken not to be denied a service on the grounds that it is “not medically necessary,” especially when the mental health clinician recommends that the treatment is necessary. .
If I received mental health services but paid for them myself, what do I need to do now to have them covered by insurance?
The answer to that is potentially a multi-step process, says Behm, who sits on the board of directors for the Georgia chapter of the American Foundation for Suicide Prevention.
First, ask if your provider is in-network. If the provider is not part of the network, look for behavioral health care providers in the network and contact them to see if they are accepting new patients.
If you can’t find a provider that works, contact the insurance company and ask them to find a provider. Another alternative is to suggest the insurance company consider a single case agreement, which would cover medically necessary treatments as if the provider were in-network
If the company is unable to suggest an alternate provider or offer you a deal on a case-by-case basis, proceed by filing a complaint with the state.
What is the procedure an insured Georgian can follow if the law is not respected?
First, call your insurance company and dispute any denial of care or unexpected charges. When doing so, keep meticulous records of every communication with an insurance company regarding a dispute, such as noting the name of the person you spoke with, the date of the call, and a summary of the conversation you had.
If you cannot find a solution with your insurance company, file a complaint against your private insurer by the Consumer Services Division within the Office of the State Insurance Commissioner.
These complaints can be filed online here. There are clear step-by-step guidelines on how to file a complaint.
For Medicaid enrollees, there is an internal appeal process unique to each Medicaid plan. If a person is not satisfied with the decision, they can appeal to the State Administrative Hearings Office.
The Atlanta Journal-Constitution is part of the Mental Health Parity Collaborative, a group of newsrooms that discuss challenges and solutions to accessing mental health care in the United States. Partners in this project include The Carter Center, Center for Public Integrity, and Newsrooms. in Arizona, California, Georgia, Illinois, Pennsylvania and Texas.