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Talk therapy about mental health parity

Conversations about mental health parity in insurance coverage trigger my repressed memory.

Whenever people become delighted that we might finally legislate mental health parity (mental health care is treated as any other illness without a cap on dollars or number of visits per year) I find myself twitching just a little bit, and licking the bottom of the valium bottle. 

That’s because mental health parity is another great example of insurance companies playing at helping the consumer find cost savings and supporting health maintenance but not delivering.

When I was negotiating health care benefits for my company the benefit directors in my town were invited to an annual lunch where we were to learn about what’s next in insurance.  The event, sponsored by Blue Cross/Blue Shield in my state, was a day of coffee, conversation with others in our field and maybe to meet the “greats” of BCBS who cared about us so much they took the time to attend our little luncheon.

We would be treated to a series of lectures about why all our premiums were going to go through the roof at renewal, and why it was really all our employees fault.  

Since the theme for the past few years had been our premiums were going up because our rotten staff was insisting on taking the medications their doctors prescribed, this year they were looking for a fresh approach. Since so many more people were already using generics and our costs still weren’t going down, it was time for a new group of employees to blame.  And who better than the frazzled, exhausted and stressed-out to make the bad guys.

During the course of the day they spent a lot of time talking about how stress leads to more serious illnesses. This made sense to us because we in HR were the ones everyone was going to hate when we stood up and told the employees how much more they were going to pay for the same care. No one had to convince the “our lady of the peptic ulcers and HR” gracing the big round tables that stress was a killer.

They even had an actuary come up and give us a bunch of numbers on a spread sheet showing just how much stress related illnesses became more serious illnesses.  it was very impressive.  And those of us who were wrecks ourselves, but never had seen a shrink got to feel all righteous. Sort of like we were willing to loose our minds for the good of the company.

I asked the speaker after about an hour of this, why, if BCBS understands that mental health effects physical health, they don’t offer mental health parity in their plan.

The guys tells me, believing I’ll be pleased, that in fact the issue was in front of the NC state legislature right then. (Of course, he didn’t point out that they were lobbying against it). I then said that to my knowledge there was absolutely no law preventing them from offering parity without the legislature’s interference. He uncomfortably agreed.

So I asked again, “if you tell me that there are huge cost savings for you and your customers if we have access to mental health, if for no other reason than to reduce stress ,why doesn’t BCBS do cover it?”   He was unable to answer me.

The truth is the sicker we get, the more they raise our premiums. BCBS of NC made 800 million in profits in Q1 of that year…and they are a not for profit company! But they still tried to raise our premiums 20% this year and we had a pretty uneventful year health wise.

They “blame the victims”. They tell us it’s our fault for taking medications that help us get better, while they lobby with big pharma for the legislature to extend the patents on drugs keeping them off the generic list for longer. They blame people for being fat, but they don’t cover gym memberships, let alone that stress is a big cause for obesity.

And while I believe in wellness programs because they are a good thing for a company to do for their employees, they don’t, as far as I have ever seen, come back to reduced premiums.

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I worry too that many citizens have sipped at the “it’s people’s fault” fountain and are now becoming intolerant with each other, rather than understanding where the problem is.  

The words “mental health parity” tend to be a trigger for me.  

So why do I twitch?  Well, after asking a series of what struck me as obvious questions through out the day, not only did they refuse to call on me when I raised my hand, I wasn’t invited back the following year.  Instead they invited one of my junior  staff from another office hoping I wouldn’t find out.

I don’t deal well with rejection. I wish I could afford a therapist, but I’ve hit my annual max!


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