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Understand your behavioral health care rights in the COVID-19 era
The COVID-19 crisis has created a devastating national health crisis, and the impacts are not just on physical well-being. Over half of Americans reported that they are experiencing increased mental health challenges because of issues associate with COVID-19.
Job furloughs and layoffs, unstable housing, social isolation and uncertainty about the future add to mental health and substance-use problems. Even before the pandemic hit, Colorado ranked No. 44 in prevalence of mental health conditions, indicating a higher prevalence of mental health issues and lower rates of access to care when compared to other states.
As we mark National Mental Health Awareness Month, all Coloradans need to know that state-regulated health plans and Health First Colorado (our state Medicaid program) cover the full spectrum of health services – not just physical health, but mental health, substance-use disorder and other behavioral services – and that state partners are ready to step in if higher cost or other limitations get in the way.
Many of us remember when mental health and substance-use treatment were not covered by health insurance at all; or only at great cost. But in recent years, there have been great strides in both federal and state policies towards ensuring that behavioral health care is treated the same way as physical health care. Under the Affordable Care Act and the Mental Health Parity and Addiction Equity Act, as well as our 2019 State Parity Act, those enrolled in state-regulated plans or Medicaid have as much of right to therapy for depression during a furlough as they do for a heart disease evaluation.
Coloradans should not face greater barriers to care when they need help with mental health or substance-use problems: What you pay out of pocket, the availability of providers in your plan’s network, pre-authorization requirements and visit limits should not make it harder to get the care needed.
New emergency state rules on telehealth also require parity, so arranging an affordable Zoom session with a social worker should not be more of a challenge than the session with the nurse practitioner to check out a rash. However, parity violations can be hard for individuals to spot.
If you or someone you know is having trouble getting or affording the mental health or substance use treatment they need, that could indicate a violation of the Parity Act. Check out CCLP’s Parity Red Flags document to help identify potential parity violations. Potential violations and questions, even if you’re not sure your health coverage is state-regulated, can be addressed by contacting the Division of Insurance (DOI).
To do their jobs enforcing parity, the DOI staff needs to know what problems you’re seeing. They have the tools to address many complaints quickly and can direct you to the right people, should the issue not involve a state-regulated plan.
Another great source — regardless of your type of coverage — is the state’s behavioral health ombudsman, who serves as a neutral party to help consumers and providers navigate issues related to consumer access to care for mental health and substance-use issues.
Whether or not you need to access behavioral health care services in these anxious and uncertain times, please well, and be good to yourself and those around you.
– By Christina Yebuah