Mental patients to lose insurance

Capital Blue Cross eliminates coverage of behavioral health from its individual plans

A recent decision by Capital Blue Cross to drop behavioral health insurance coverage from its individual plans will leave thousands of mental patients unable to pay for their therapy, doctor's visits and medication. The move, effective in January, has forced 3,400 of the insurer's affected members to scramble to secure a new provider -- facing myriad bureaucratic obstacles.

The outlook appears grim to a population that is already stigmatized, said Janet Bandics, director of the National Alliance on Mental Illness in the Lehigh Valley. For the past two weeks, she has been struggling to help mental patients get another form of coverage.

Ms. Bandics said Capital Blue Cross did not provide its members with enough assistance or enough time to go through the administrative process of changing health plans. She said many of them are desperate and "don't know where to start."

"It's like telling somebody who has cancer: 'Next year we are not covering cancer,' " Ms. Bandics said.

Capital Blue Cross has its headquarters in Harrisburg and provides health insurance in 21 counties in central Pennsylvania.

With the clock ticking, the advocacy group is seeking an emergency meeting with Capital Blue Cross, hoping to persuade the company to reverse its decision, said James Jordan, executive director of NAMI Pennsylvania.

"We are hoping for compassion and understanding on the part of Capital Blue Cross for the people who are affected by this," Mr. Jordan said. "The potential of a bleak future is great for those who are losing their coverage."

It was a business decision, said Cindy Hatcher, senior director of individual products at Capital Blue Cross.

Ms. Hatcher said an increase in health costs forced the company to eliminate its mental health coverage for individual plans. Premiums would have increased by 10 percent, on top of the 9.9 percent that is already expected for next year, if it maintained its behavioral care. The company was afraid its members would not be able to afford medical coverage.

"We want to serve these people," Ms. Hatcher said, "but we want to provide them with a coverage that they can afford."

For Ms. Bandics, the fact that Capital Blue Cross chose to leave mental patients uncovered heightens the disparity between the treatment of physical and psychological conditions.

The Mental Health Parity and Addiction Equity Act, signed in 2008, requires insurers to provide the same level of benefits for mental illness or substance abuse as for other physical disorders and diseases. Unable to meet the additional cost to comply with the law, Capital Blue Cross chose to eliminate mental health care for individual plans, Ms. Hatcher said. Other companies have done the same at the national level.

"It was so important that we as a society passed the Parity Act so that mental health treatment was put on par with physical health," said Christine Nelson, executive director at the Lehigh County Conference of Churches, which assists indigents with medical conditions. "For companies to be seeking to circumvent that is unfair and outrageous."

The change by Capital Blue Cross will affect only those who are self-employed with an individual plan. It's unclear whether the decision will apply to other Blue Cross affiliates at the national level. Other major insurance companies contacted indicated they plan to maintain their current coverage.

A total of 13.4 percent of adults in the United States received treatment for a mental health problem in 2008, according to a survey by the National Institute of Mental Health. This includes all adults who received care in inpatient or outpatient settings and used prescription medication for mental or emotional problems.

One of the main obstacles that these patients face is that their pre-existing behavioral conditions may prevent them from receiving immediate coverage by another provider.

The Patient Protection and Affordable Care Act, signed into law in March, contains a provision that bars insurance companies from denying care to patients with pre-existing conditions. The measure is in effect for those younger than 19 but does not kick in for adults until 2014.

The law also precludes companies from eliminating behavioral care from group plans, according to David Gates, policy director at the Pennsylvania Health Law Project. But those who insure themselves and their families through individual policies are without protection.

"I've got to say this is going to be really be tough," Mr. Gates said.

But there might be a solution, he said.

The Health Insurance Portability and Accountability Act provides some protection for those with pre-existing conditions who may need to change their insurance plan.

The safeguard is known as the Certificate of Creditable Coverage.

Patients would be able to go to a new health care provider and buy coverage, even with a pre-existing condition. They need to have been insured, however, for 18 months for the provision to apply.

Ms. Hatcher said Capital Blue Cross would be willing to issue the certificate for those who qualify for it.

"All they have to do is contact us and request it, and we will make every effort to expedite it," Ms. Hatcher said.

But everyone might not be able to benefit from this solution, and Mr. Jordan said he is concerned about the immediate effects of Capital Blue Cross' decision.

Without proper care, those who would normally be able to go to work and lead productive lives might be in crisis.

"The impact on the lives of these people will be devastating," Mr. Jordan said.

The advocacy group is resorting to dialogue first but will seek other avenues if the insurance company does not respond to concerns.

"We won't just go away," Mr. Jordan said.

Reporter Scott Kraus contributed to this story.

First published on December 24, 2010 at 12:00 am