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November 16, 2018
Mental Disability and Health Care Coverage

Anyone who has suffered from mental problems knows how much disabling it can be. For all practical purposes, the mental disability might be more disabling than any other critical illness or even physical disability. A physically disabled person tries to get over his challenges using his willpower and mental prowess. The irony with a mentally disabled person is that he struggles due to his crippled mind. The health care coverage for mental disability thus becomes essential for the patient.

Mental disability is more common than what is generally assumed. The underestimated critical illnesses due to mental health disorders affect about 1 in 5 Canadians. It is a concern that though there are so many critical illnesses and disorders associated with mental health, only 1 in 5 of Canadian children patients receives treatment. Due to the stigma attached to the mental illness about 49% of those affected would never visit a doctor. The hypocrisy of our society is exposed, considering that 53% consider even minor mental illnesses like anxiety and depression as an epidemic. A conservative figure for the economic cost would be totaling (including care, disability, and early death) around $8 billion.

Despite the various mental health acts passed, the insurance companies seek and use the loopholes to skimp on mental health coverage. The patients due to the improper mental health coverage struggle to get access to the treatment for critical illnesses like- suicidal behavior, personality disorders, bipolar disorders, schizophrenia, and major depression.

High Cost of the Coverage

The cost of mental health coverage is ever increasing. An annual increase of 10-15% is quite common for the insurance industry. When we consider the fact that there are also some essential services for the mental health patients which are not at all covered by the insurance, then it makes the coverage cost appear even higher.

Impractical Wait Time

Just because you have subscribed to a mental insurance health policy doesn’t necessarily means that it would be fruitful for you. Every insurance company has their own PPO’s (preferred partner organizations) or appointed psychiatrists. Your mental healthcare coverage only covers the visit to these organizations or practitioners. So, what should be wrong with that? Right? Well, that’s the catch! There is a wait time. No, it is not for days or weeks. It is generally for months and sometimes may even be for a year or longer term. Think realistically, is it possible for anyone to wait that long when the patient needs medication immediately?

That compels you to seek alternative ways. The other two options are- hiring a private psychologist or a social worker. In both the cases, you have to pay through the nose. You will end up paying roughly about $120 per hour on an average. Such high rates even let patients suffering from critical illnesses to hesitate to go for the treatment.

Out of Network PPO’s

The PPO’s and affiliated practitioners for mental health disorders are 4-6 times more likely to be out of network than the other medical care providers. Though statistics may vary, but on an average, about 45% of PPO’s are out of network at any given point of time. The wait time on the working PPO’s and psychiatrists increase by many folds due to the out of network clinics. The patients or families end up paying the huge amount of fees out of their own pockets to consult the psychologists, outside of the preferred network of insurers. 

Coverage Gap

Not all the patients qualify for the insurance coverage. The insurers might reject your proposal if they judge that your mental disorder does not qualify for coverage to be as per their terms. They do have the right to do so. They might also reject your claim stating lack of evidence. The purview of the coverage must be increased to cover as many mental health issues as possible.

Low Payout on Claims

On an average, the insurance companies pay 20% less to claims regarding behavior illness in comparison to any other medical reasons. This is quite unfair, and the practice must be abolished as soon as possible.

Low Reimbursement Rates

The insurance companies pay on an average of around 80 cents for every $1. The low rate of reimbursement results in discouragement of mental health care professionals to approach insurance companies. As a result, the insurers find it difficult to broaden their preferred networks. Also, the insurers do not reimburse for the services of physical therapists and caregivers, whose services are perhaps as important as the treatment itself.

Refusal of Insurance

There are numerous insurances wherein the insurance companies have deliberately tried to avoid mental health patients. They sometimes even refuse the applicants suffering from mental problems without bothering to inform any just reason. This type of indifferent reactions from insurers further aggravates the financial challenges for the patients already in turmoil due to their mental issues.

There are also other tricky situations, which the regulators need to fix to benefit the patients. An example would be how employers are allowed to withdraw the insurance coverage from their employees in case they are suffering from mental health problems. The insurance companies ideally should be more considerate of the patients suffering from mental health disorders. They should make a profit but not at the cost of patients suffering from such critical illness. Making the terms and conditions more comprehensible will certainly help the patients.

The situation, however, has improved recently. More and more consumers are getting benefitted from mental health care coverage. Are you looking for comprehensive health care coverage solutions in Edmonton? You may get in touch with our experts, Justin and Amy. They will educate and guide you to get the best plan.

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