Society has long looked down on mental health patients, according to Andrew Malekoff, executive director of the Roslyn Heights-based North Shore Child & Family Guidance Center. So it has been all too easy for insurance companies to treat them as second-class citizens, often refusing reimbursements to care providers and hiking copayments for treatment.
Ailments of the mind have never been on a par with physical diseases, such as cancer or heart disease, Malekoff says. Rather, society stigmatizes mental health patients. Their issues, it is commonly believed, are of their own doing, not the result of variations in the brain’s biochemistry or its neural network.
Malekoff recently met with the Heralds’ editorial board to discuss the complex insurance issues associated with mental health.
In particular, drug addicts are seen as less worthy by insurers. If users hadn’t taken drugs in the first place, they never would have wound up in treatment, so they should just deal with it, the thinking goes.
All of us feel a deep sense of sympathy for a lung cancer patient, even if that patient spent a lifetime inhaling a pack of cigarettes a day. We can comprehend, if only on a basic level, the insidious mutations in lung structure that cancer causes. We understand the terrible, painful death that any cancer patient potentially faces.
But what of the schizophrenic stumbling aimlessly along a city street, talking gibberish? We move away, fearful. We don’t understand this lost soul’s tortured mind — or how to help. We feel little or no sympathy, particularly given the mythology that such patients are a possible danger to society.
In rare instances, the mentally impaired do pose a physical threat. More often, they are victimized by bullies and vigilantes, beaten and chased out of town.
Mental health parity laws were supposed to make issues of the mind equal to those of the body, according to Malekoff. They haven’t, however. In New York state, Timothy’s Law, passed by the Legislature and signed into law by Gov. George Pataki in 2006, was supposed to ensure parity between treatments for mental and physical health. The law was named for a middle school student from upstate Schenectady who suffered from severe depression and a host of other mental health issues, and killed himself when he was just 12 years old. His family could no longer afford treatment after their insurance benefits had run out.
Timothy’s Law took effect in 2007, and in 2009, the State Insurance Department reported that the law had significantly increased treatment for mental health patients. Lax enforcement, however, allowed the insurance companies to slip back into their old ways, according to a study released by the North Shore Child & Family Guidance Center last January, titled “Project Access.”
2018 marked the 10th anniversary of the federal Mental Health Parity and Addiction Equity Act. It has never, however, brought true parity in New York and in states around the country, according to Malekoff.
In December, Gov. Andrew Cuomo signed the Mental Health and Substance Use Disorder Parity Report Act, which requires health insurance companies to report directly to the State Department of Financial Services and the commissioner of health on insurance payments for mental health patients. At the end of the year, Financial Services must prepare a report assessing the degree to which insurers are complying with mental health parity laws. The measure will take effect Sept. 1.
The annual report, according to Malekoff, will provide desperately needed accountability. Compiling a yearly report is one thing. Making sure that the insurance companies are actually complying not only with the reporting measure, but also with the mental healthy parity laws themselves, is another.
For starters, Financial Services will have to verify the information reported by the insurance companies to ensure its accuracy, Malekoff says. If state officials then find that the insurers are out of sync with the law, they will likely have to litigate to force compliance.
That’s never an easy proposition. Lawsuits are costly, and insurance companies understand that state officials are often reluctant to litigate because of the expense, particularly in an era of state budget constraints. So our Assembly and Senate representatives will have to provide oversight of Financial Services and the health commissioner to ensure that they do their jobs.
Otherwise, mental health patients will remain as they long have been — in the shadows, ignored and hurting.