http://www.npr.org/templates/story/story.php?storyId=95435676

Regarding what is happening in your state, I would suggest that you contact your insurance companies and get informed about how and when they’ll change their policies.

Parity has been a long, hard fought issue for psychologists for many decades. Thanks to their dedication and the contributions of its members, APA and all mental health workers have realized that lobbying for the rights of mental health patients can work! That’s why we here in PA have fought so hard against the ridiculous use of authorizations. Now that we have gotten rid of auths for 90% of insurance companies, “need” is being defined in more clinically useful methods.

Parity: It affects all commercial health care plans including employer sponsored plans that are not subject to state regulations (called ERISA exempt). In Pennsylvania that is about one half of the commercial health care plans.

It does not apply to business that have less than 50 employees. However, some of those businesses may voluntarily purchase policies that have mental health parity.

The bill does not apply to Medicare or Medicaid. Medicaid in PA already has parity. Medicare will be gradually moving to parity by 2014. Parity for Medicare will be phased in gradually until 2014. Right now Medicare pays 50% for outpatient psychiatric services, but by 2014, it will pay 80% of
outpatient psychiatric services, the same percentage that it pays for other medical procedures.

All legislation of this nature has a phase in period, believed to be January 2010.

The two major changes for psychologists will be that

1. for almost all patients (all except those who work for business with 50 or fewer employees), the copays for mental health treatment will be the same as for physical health appointments. PPA data shows that patients with higher copays use fewer outpatient treatment sessions than those with lower copays.

2. patients with serious mental disorders (all except those who work for businesses with 50 or fewer employees), will no longer have arbitrary limits on the number of outpatient sessions or inpatient stays. Of course we know that managed care already restricts inpatient care and outpatient care through medical necessity reviews; this will not change.

Thanks very much for creating the SOS blog! I have never been involved in a blog before and am excited to see how this develops. I think it is a great idea. Thanks also for David Pogue’s article. Although when I read the following line in his article: “…Nobody, but nobody, is going to give you half of $80 million to help them liberate the funds of a deceased millionaire…from Nigeria or anywhere else…” I became quite depressed and realized the only way to survive the current & future economic hard times is to fine tune our practice’s ability to obtain payment from the insurance carriers.

As I understand it the “bail out” just signed by President Bush has a mental health “parity” component attached to it. Do others worry that insurance companies will find loop-holes to avoid following the rules associated with parity??

Dave Zachau
Elyria, Ohio