Mental and Physical Health Care: Equal Under Law, Still Separate

A report from the National Alliance of Mental Illness casts a pall on the dream of mental health parity—the federally legislated mandate that insurers reimburse mental health care providers at the same rate as those health professionals who treat physical illness. A key NAMI finding (based on a survey of consumers) is that insurance companies deny mental health claims twice as often as they do physical illness claims, based on questions about “medical necessity.”

From NPR: “Basically, they look at someone’s care and ask is it really medically necessary. And advocates say they’re applying those sorts of cost-control techniques way more stringently on the mental health side and the substance abuse side than they are on the physical health side.”

However, according to NAMI, there is no reason to think that the “medical necessity” of mental health care should be any different from physical care. The Mental Health Parity and Addiction Equity Act was intended to erase this disconnect. As the NAMI report says, “the reasonable expectation is that reported denials of care for mental health, substance use, and medical care would be roughly equal.”

Not so. The survey shows that 29% of families “had been denied mental health care on the basis of medical necessity, more than twice the percentage who reported being denied general medical care.”

The law (or the difficulty enforcing it) is not all to blame for the poor state of mental health care in the United States, NAMI admits. There aren’t enough professionals; the ones we have are understandably wary of working with stingy insurance companies; and the lack of a robust mental health system means that many needy children and families go unrecognized.

But for the families who do reach a professional, we hope we can do better than turning them away because treating a mental illness isn’t a “medical necessity.”