My Therapist Has A Golden Heart – Mental Health
The Fourth House
by – Sheri de Grom
The headlines read, “Obamacare Should Help Those With Mental Health Issues Advocates Say.” The operative word in the previous proclamation is ‘SHOULD.’
I was enraged while watching a live interview of President Obama with Liza Zamosky
on March 16, 2014. During the interview he answered questions about the Affordable Care Act. I couldn’t (or didn’t want to believe it) when I heard the President of the United States say, “We choose what we think is best for you.”
How does the President or any other pencil pusher know what medical care is best for me. The administration has met their goal’ they’ve managed to socialize our health care.
Health Day, reporting news for healthier living, reports people with mental health issues are discovering ways that the legislation directly affects them.
Before I stop writing about this so-called landmark legislation, I’ll bring you proof wherein the Affordable Care Act (ACA) has closed the door of mental health care on millions of Americans that HAD MENTAL HEALTH CARE COVERAGE BEFORE OBAMACARE and now that coverage is gone.
Health Day reported on Oct. 15, 2013, that an estimated 32 million people will gain mental health or substance abuse disorder benefits, or both, as a result of the Affordable Care Act, according to the U.S. Department of Health and Human Services.
Obamacare likes to take the credit for writing parity into mental health legislation. They are treating it as if no one could have possibly thought of this idea before. How arrogant can one administration be with the lives of its citizens at stake?
Parity in mental health care was first written into law in the 80’s. I know this because my own federal insurance plan paid all medical claims at 80% and others at 100%. However, all of my husband’s mental health care claims were paid at 50%. I knew I had to find someone who not only I could help but someone who could help me.
Care for my husband was going to be in the millions and even more and I would never have the 50% I needed to cover our cost-share. Thus, my first adventure into writing a legislative proposal was born and my career took flight at the same time.
Fortunately, I was working at JAG at the time and had access to the latest legal information on the subject of case-law regarding all health issues, not just mental health. I searched the Federal Register (it’s the official journal of the federal government of the United States that contains most routine publications and public notices of government agencies and I might add, it is boring to read. I suspect the reason so many administrative laws pass is the individuals assigned to comb through the Registers every day, simply don’t). I also had access to Westlaw (an online legal research dedicated to law). I wrote up a proposal and two weeks later was boarding a flight to D.C. to meet with the late Senator(s) Ted Kennedy and Paul Wellstone. I knew the two senators were my best bet for achieving my goal as they were both passionate about mental health law and ways to improve coverage.
The senators were a bit taken back by my insistence on the urgency of passing legislation regarding parity being written into mental health law but they were more than willing to assign staffers to help me refine the final bill and with their support, we gained approval for all federal and many Fortune 500 insurance plans to cover mental health at 100% or the same as all other illnesses.
I learned how degrading and ugly insurance company lobbyists were. Pharmacy and other health care lobbyists joined in the fight against legislation.
Today’s Affordable Care Act has written parity into the law so mental health coverage should be much easier to access. Again, ‘should’ is the operative word.
Andrew Sperling, director of legislation advocacy for the National Alliance on Mental Illness (NAMI), is somewhat circumspect about the changes and is in a waiting position to see how well what’s promised will actually deliver.
A specific problem NAMI has is a result of the Supreme Court decision, the Medicaid expansion is optional, and a large number of states are talking about not participating. Mr. Sperling continued, “Some of the benefits vary depending on where people live,” he explained, “people in some states won’t see the full benefits accorded by the law.”
Additional concerns expressed by providers regarding mental health coverage and the ACA include:
- Providers are still required to obtain prior authorization for treatment sessions. This can result in endless paperwork and numerous telephone calls before authorization is received.
- Evidence-based practice does have standard lengths of time for support. A patient may be in treatment for post-traumatic stress disorder, and evidence may suggest that 12 weeks is the standard, and once someone is out of the extreme crisis, group treatment may be an option. [In later posts I’ll talk about my own experience with PTSD treatment and why 12 weeks wouldn’t have uncovered the surface and allowed me to work in a group).
- Though some want no limits on the number of treatments available for someone with a mental health disorder, the law now mandates that all insurers offer a length of treatment that’s on par with what’s available for other health issues.
Access to mental health care is more difficult than ever to obtain. In a later blog I’ll talk about how mental health care has now become a cash-only business for more than 50% of all members of The American Psychiatric Association.
My therapist goes above and beyond in her insistence that she believes one day I’ll get everything sorted out. I’ve been billing Medicare myself as she is not a Medicare provider. I don’t want Medicare to pay her and they are not obligated to pay her. With each claim I submit and every time I call Medicare (minimum of once a week), I remind them that the only thing I want is for them to deny my claim with the proper code so that I then can submit the claim to my Federal Blue Cross/Blue Shield who will then pay for her services. I’ll be blogging in-depth about this subject later). Blue Cross/Blue Shield will pay my claims if and when Medicare cooperates with my request(s). I’M REQUIRED TO BILL MEDICARE FIRST ALTHOUGH THEY HAVE NO OBLIGATION TO PAY.
My next step is to ask my congressional representatives’ and other national mental health advocates to help me in my efforts to teach Medicare how to interrupt the existing law.
My therapist has never asked me for payment for her services. She has not been paid since 2012 when I turned 65. Before I turned 65, my mental health care claims were paid at 100%. Now that I’ve become a so-called senior citizen, I’m relegated to a citizen with no mental health care with the exception of having a mental health provider with a golden heart. She recognizes my tough woman persona and when it comes crashing down, she gently helps me to the other side.
To be continued . . .