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Ask the Mental Health Expert Archives 2001-2004

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Depression Coverage

Q. I was wondering if any lobbying is being done with the health insurance industry regarding depressive disorders and their treatment. I have to switch health insurance policies due to an exorbitant COBRA policy premium, and I was informed that several applications for health insurance have been declined due to the fact that I am on maintenance medication for depression. If depression is indeed a chemical imbalance in the brain, then why isn't it considered a medical disorder such as diabetes or high blood pressure? Isn't this attitude rather 19th century? What is your expert opinion on this dilemma?

A.Yes, a good deal of lobbying on this controversial matter is in the works. For example, in Massachusetts, The National Alliance for the Mentally Ill (NAMI) recently called for immediate and full passage of S2165, which would amend the Massachusetts insurance laws so that mental illness is covered in the same way as other biologically based diseases.

S2165 requires that health insurers treat adults with serious mental illness and children with serious emotional disturbances in the same way as people with other physical illnesses. The bill covers inpatient, intermediate, and outpatient treatment. It removes the $500 ceiling on outpatient treatment and eliminates discriminatory co-payments and annual and lifetime caps on expenditures. It also requires equal coverage for patients with alcohol or chemical dependency. S2165 would apply to all insurance companies, Blue Cross and Blue Shield, and health maintenance organization plans in the Commonwealth.

The bill passed unanimously in the Mass. Senate on April 2nd, 2002, (by a vote of 38 - 0), is now under consideration in the House Ways & Means Committee. Seventeen other states, including every other state in New England, have already enacted parity laws, and bills in two other states are awaiting signature by the Governor. NAMI Executive Director Laurie Flynn had this to say, and I am sure you will agree: "It is ironic that Massachusetts, home to world-class hospitals and site of some of the most impressive scientific breakthroughs in the understanding of mental illness, continues to lag behind the rest of the country when it comes to health insurance coverage," said... "It is time for the Bay State's out-of-date insurance system to reflect what science has already proven time and again: that mental illnesses are biologically based disorders and that treatment for diseases such as depression, manic depression and schizophrenia are often just as effective as those for heart disease and cancer."

I certainly agree with this, though I think the term "biologically-based" somewhat oversimplifies the issue. Most severe psychiatric disorders are actually "bio-psycho-social" conditions, with important cognitive and social components. (Here's a brief illustration: While bipolar disorder is strongly driven by biogenetic factors, I recall a patient of mine who used to soar into a manic episode every time she ran in to her ex-husband!).

For help and advice on dealing with your own insurance problems, you might want to speak with someone at NAMI (800-950-NAMI). Good luck with your efforts.

February 2003

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