A young woman sits on a couch with her therapist.
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The Biden administration plans to crack down on health insurance programs that discriminate against people who need mental health care and substance abuse treatment.
The U.S. Departments of Health and Human Services, Labor and Treasury released a proposed rule Tuesday aimed at pushing health insurers to comply with the Mental Health Equity and Equity in Addiction Act.
Passed in 2008, the law requires insurance plans covering mental health care and substance abuse treatment to provide the same level of coverage for those services as for other conditions.
White House domestic policy adviser Neera Tanden told reporters on a conference call Monday that too many insurance companies are evading the law and making it difficult for patients to access mental health care.
Insurance plans often fail to provide enough therapists in-network, forcing patients to seek treatment out-of-network and pay more. Patients also often have to get permission from their insurance companies to seek treatment, or their claims are denied, leaving them with the bill.
“That means millions of people with insurance are paying out of pocket when they don’t have to,” Tandon said.
According to the National Institute of Mental Health, more than one in five American adults, or 58 million people, suffer from a mental illness.
The proposed rule would require insurance plans to evaluate how their coverage policies affect patients’ access to mental health and substance abuse treatment, Tandon said.
If insurers do not comply with the law, they will be required to take action, she said. This could include adding more therapists to the insurance network if patients seek out-of-network treatment too frequently, Tandon said.
The proposed rule will undergo a 60-day public comment period before being finalized.
A survey of nearly 2,800 patients released in July found that people with insurance face more challenges accessing mental health services than other types of health care.
Nearly 40 percent of people who enroll in insurance through their employer have to seek out-of-network, more expensive mental health care or substance abuse treatment, according to a survey by research group NORC. In contrast, 15 percent of those seeking physical care were out of network.
More than 50 percent of patients said their insurance had been denied coverage for mental health or substance abuse services 3 or more times, while 33 percent said they had been denied coverage for physical health care as well.
Nearly 60 percent of respondents who sought mental health care or substance abuse treatment did not receive any care at least once.