How Does Having a Bipolar Diagnosis Affect My Insurance?
If you have been diagnosed with having bipolar disorder, you are not alone. According to the National Institute of Mental Health, over five million American adults are affected by bipolar disorder in a given year. In addition over 60 per cent of people with bipolar disorder also struggle with a substance abuse disorder according to the National Alliance of Mental Illness. Psych Central reports that these two problems occur together so frequently that some experts suggest that all young adults with a bipolar diagnosis should be screened for possible additional problems.
The two go hand in hand: the discomfort you feel from the chaotic moods can be so disturbing that you will do anything (including taking drugs) to stop feeling so unsettled.
In previous years many people who suffered from bipolar disorder also suffered stigma and discrimination because they had a mental health disorder. Neither scientists nor doctors fully understood the nature of the disease, and insurance companies were unwilling to pay for treatment. Some people were dropped from their insurance companies.
Others were denied treatment because the disorder was considered a pre-existing condition. If insurance did cover bipolar disorder under its benefits, the companies required higher premiums, set different yearly or lifetime limits and lowered the benefits given to the person insured. Undoubtedly this made treatment more difficult to obtain and maintain. Fortunately, recent laws have been created and enacted to remove the unfair treatment of mental health disorders.
The Mental Health Parity and Addiction Equity Act, or MHPAEA
The Mental Health Parity and Addiction Equity Act (also known as the Parity Law or MHPAEA), was passed as law in 2008 and was enacted in 2010. According to the U.S. Department of Labor, the Parity Law requires health insurance carriers to treat mental illness with the same terms and conditions as any other illness like diabetes or an appendectomy. As a part of the MHPAEA, insurance companies must provide equal limits on the number of days or visits for treating a mental illness that is provided for a physical condition.
According to the American Psychological Association, most health plans do not have annual limits on the number of office visits for medical care, so the same opportunities must be made available for treating bipolar disorder. Furthermore, an insurance company must also make deductibles and out-of-pocket limits equal as well. The law also denies insurance companies the ability to deny coverage of bipolar disorder as a pre-existing condition.
Important Things to Know about the Parity Act
The Mental Health Parity and Addiction Equity Act applies only to private or public-sector employers who have more than 50 employees on the payroll, but nearly all employer-sponsored health plans in the U.S. provide mental health benefits even if the company is small. Furthermore, if an individual state has stricter requirements for providing mental health coverage, the insurance companies in that state must comply with that law.
It is important to know that insurance carriers do not necessarily have to offer mental health insurance at all. However, if a company offers a policy that provides for physical health, then it must provide equal treatment for mental illnesses like bipolar disorder. On a positive note, less than two per cent of companies dropped their mental health coverage because of the Parity Act. This means that getting help for bipolar disorder should be easier.
It is also important to know that the federal law does not outline specifically what mental disorders must be covered by insurance. Rather the federal law allows each state to define what is to be covered according to the National Alliance on Mental Illness. However, given the prevalence of the bipolar disorder in the United States, your insurance company likely covers the condition. A quick call to your benefits hotline will provide the answer to that question.
The Parity Law applies to several state and federal entities. For example, Medicaid managed-care programs, the Children’s Health Insurance Program and the Medicaid Alternative Benefit Plan all must comply with the law and provide you with help with your bipolar disorder. In addition, if you have insurance through the Federal Employees Health Benefits Program, your condition is also covered.
If you …