Government mandated essential healthcare benefits under the Affordable Care Act (ACA) heralds a time when consumers can look to their insurer to deliver improved health outcomes as part of their consumer contract.
In many instances, such as maternity benefits and screenings, the law simply codifies benefits that have long been in place under many health insurance plans. And, it makes sense too, since pre-natal care and screenings help us to reduce rates of infant mortality and pre-empt potentially life-threatening diseases – such as diabetes, cancer and heart disease.
Raising Behavioral Healthcare Parity Under the ACA
One set of services, behavioral healthcare, has been the focus of advocates, including providers of behavioral healthcare who seek reimbursement parity with their medical/surgical peers.
Advocates argue that treatments for physical ailments have traditionally received the bulk of the insurance dollars, while a greater responsibility for payment of services related to behavioral health issues have been forced onto the consumer.
In November, Congress added clarity to the rules set forth in the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA).
The new rules proscribe against insurer policies that would limit access, requiring that services and payments be equitable, and access to behavioral healthcare “benefits are no more restrictive than the predominant requirements or limitations applied to substantially all medical/surgical benefits.”
As part of this effort to increase access and raise parity, Vice President Joe Biden recently announced the Obama administration’s decision to add $100 million toward behavioral health services.
The $100 million would be used to educate and train new behavioral healthcare providers, as well as educate primary care physicians – who are often at the forefront of care and who may have the best ability to recognize, treat and refer patients for more specialized behavioral healthcare.
Consumer Protections Inherent in the ACA
Since the act itself is predicated on consumer rights, the ACA could be used to bolster previously instituted parity laws. The ACA is not intended to simply maintain a status quo, but to ensure that consumer choice in access to providers is combined with fair and equitable distribution of healthcare dollars to providers of these services.
There will always be a need for providers to service our physical aches and pains – consumers also need technologists, who can help in diagnosing conditions before they manifest into disease. In addition to services for physical pain, consumers need equitable access to those providers who can help guide them when they are struggling due to mental health or substance abuse issues.
Education and Advocacy Under the ACA
Providers who have maintained a more conservative approach to healthcare, or haven’t considered the connection between mind and body, may need more education to help them to become a better partner in the care of their patients.
In the end, consumers themselves will need to be wiser users of healthcare dollars – asking better questions of insurers and asking that insurers consider therapeutic options that would save dollars, improve health outcomes and truly delivery on the full range of promises under the ACA.
