Depression and health insurance

Depression & Health Insurance Coverage

Written by WebMD Editorial Contributors

Depression Screening

You should be able to get evaluated for depression free of charge. Most plans must offer this as a preventive service.

Only so-called grandfathered plans offered by employers do not have to offer free screening. These are plans that were in place before the Affordable Care Act was signed into law on March 23, 2010 and have not substantially changed. Read your plan's summary of benefits to see what's covered and how much your share of the cost is.

Depression Treatment

Treatment for mental health conditions, including depression, is one of the 10 essential health benefits. The Affordable Care Act requires all health plans sold on state Marketplaces, in the individual market, and through small employers – those with 50 or fewer employees – to include essential health benefits. Each state sets the details of the required mental health coverage, however, so coverage may vary from state to state. Most plans will cover treatments such as:

Psychotherapy
Medicine for depression
Inpatient mental health treatment
Case management
Crisis intervention

You might even find your family doctor taking part in your depression treatment. As part of health reform, primary care doctors are urged to work with specialists on complex conditions like depression. Your doctor may screen you for depression at a routine visit and treat your symptoms.

The goal is to make it easier for you to treat your depression. And, with the right treatment, you may be better able to prevent a relapse.

Other Protections

Besides new benefits, the Affordable Care Act protects your insurance coverage in several ways:

You cannot be dropped from your plan because you have depression.
You cannot be turned down for coverage or charged more for your insurance because you have depression.
Your children can stay on your plan until they reach age 26.
Your plan cannot put a dollar limit on how much it spends on your care. There are no more annual and lifetime limits.
Your out-of-pocket costs are capped. There's a limit on how much you will spend each year. After reaching that amount, your plan covers all costs. That includes copays and deductibles.

Savings on Depression Drug Costs for Seniors

If you have Medicare and take medicine for depression, you may be pleased to know that the donut hole -- the gap in Medicare coverage for prescription drugs -- is slowly going away. It will be gone by 2020, leaving you to pay just 25% of the cost of your brand-name and generic medications. See "What Medicare Costs, Part D" to get the details, including what discounts are available until the donut hole closes.

Is Depression a Pre-Existing Condition?

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HomeKnowledge CenterIs Depression a Pre-Existing Condition?

Learn about how a depression diagnosis effects your coverage.

Depression is not a simple case of the "blues." In fact, depression can be a very serious illness that left untreated can have long-term effects on your health, both emotionally and physically. When you’re considering choices in health plans, it’s important to know if depression is covered as a pre-existing condition and under what terms.

When is depression a pre-existing condition?

In health insurance terms, depression is a pre-existing condition if you have seen a provider for it or been diagnosed with it during a specified period of time before you sign up for a new health plan. Like other pre-existing conditions, depression is often a long-term condition that may require on-going care and treatment. This long-term care may extend over the life of many health plans. Before the Affordable Care Act (ACA) was enacted, health insurers could refuse you coverage for pre-existing conditions, including depression. Or, they could offer you coverage at much higher rates.

Can you be denied coverage for depression that’s pre-existing?

The Affordable Care Act (ACA) made it illegal for insurance companies to refuse you coverage for a pre-existing condition like depression, along with many other kinds of pre-existing conditions. This law applies to health plans that continue to follow ACA guidelines. ACA plans cannot charge you more or raise your rates just because you have been diagnosed, have received, or are currently receiving treatment for depression.

As the political landscape shifts, there could be new health plans made available that do not follow ACA standards. They may not offer coverage for pre-existing conditions such as depression. Make sure you understand all the details of any health plan before enrolling, especially how pre-existing conditions are covered.

What is the best insurance for pre-existing depression?

Depression may be covered under many different types of health plans, as part of mental health and substance use coverage, sometimes called behavioral health coverage. This type of coverage is included in many medical plans:

If you are buying insurance on your own and not through an employer, shop for individual health plans through the Health Insurance Marketplace at HealthCare.gov . These health plans are typically ACA-compliant, which means they cover eligible treatment for pre-existing depression. You will want to choose a health plan that covers treatment for mental health and substance use, or behavioral health.
If you get your health plan through your employer, you will likely have a few plans to choose from. To find out if depression is covered as a pre-existing condition, read the details of each plan. Make sure the plan you choose includes coverage for mental health and substance use, or behavioral health.

Always ask questions if you are unsure whether pre-existing conditions are covered.

Do all health plans have to cover depression as a pre-existing condition?

All ACA-compliant health plans you buy on your own through the Health Insurance Marketplace will cover pre-existing conditions. You will need to purchase a plan that offers coverage for mental health and substance use, or behavioral health to have coverage for depression that’s pre-existing.

Health plans you get through your employer that come from major health insurance carriers will also typically consider depression a pre-existing condition. Exceptions would be plans that do not provide comprehensive medical coverage, such as some short-term, catastrophic health plans, or supplemental health plans like vision or disability.

Grandfathered health plans, or those enrolled in prior to 2010, are not required to cover pre-existing depression. These are much less common.

As the health insurance industry changes, there could be certain types of health plans entering the market that do not cover pre-existing conditions. It’s important to shop for health plans carefully and know ahead of time if depression is covered as a pre-existing condition.

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This information is for educational purposes only. It is not medical advice. Always consult your doctor for appropriate examinations, treatment, testing, and care recommendations. Any third party content is the responsibility of such third party. Cigna does not endorse or guarantee the accuracy of any third party content and is not responsible for such content. Your access to and use of this content is at your sole risk.

Sources:
Mental health & substance abuse coverage, HealthCare.gov , accessed June 30, 2021.

Murderous Greed Millions of Americans die because of bad insurance. The problem has not been solved for 10 years: Social sphere: Economics: Lenta.ru

The United States is mired in a mental crisis - millions of Americans are on the verge of suicide because they cannot get psychiatric help. Insurance companies use any excuse not to pay for the services of psychologists and psychiatrists: they deceive clients, hide behind various interpretations of the law, deliberately delay or underestimate insurance payments. The problem has reached such a scale that the average life expectancy of the entire population has begun to fall at the federal level. The problem has existed for 10 years, but the authorities still have not been able to find a competent solution. The greed of the insurance business worth millions of human lives - in the material "Lenta.ru".

Mental crisis

A psychiatrist is a person with a professional medical background who deals with the diagnosis and treatment of mental disorders. A psychologist is any person with a higher education in the humanities who has undergone special training in applied or scientific psychology. He works with the problems of people who do not have disorders.

America is in a mental health crisis. According to the non-profit organization Mental Health America, for 2019mental problems were identified in 18.07 percent of the population (more than 44 million people). Nearly half of all Americans are substance abusers, and 9.6 million have suicidal thoughts. More and more young people are suffering from mental disorders. For example, the proportion of millennials (the generation born after 1981) with depression rose from 11.93 percent in 2015 to 12.63 percent in 2018. According to the Centers for Disease Control and Prevention (CDC) data for 2015-2017, due to mental health problems, life expectancy in the United States has declined for the first time in a century for three years in a row. This happened despite advances in the fight against cancer and heart disease, at the expense of an increase in suicides and unintentional injuries, including drug overdoses. For example, in 2017, 47,000 Americans died by suicide, 70,000 by overdose, and about 17.3 million adults were seriously affected by bouts of depression.

Photo: Paul Sancya / AP

Mental illness is costly, according to the American Psychological Association, with the US economy losing about 217 million workdays each year. The decline in productivity is associated with mental illness and substance abuse, with indirect business losses ranging from $79 billion to $105 billion a year.

The Cohen Veterans Network (CVN) National Charity and the National Council on Behavioral Health last year conducted a major survey of the availability of mental health care in the country. Demand for these services is higher than ever, with 56 percent of Americans dreaming of finding a doctor for themselves or a loved one. Many of them are young, have low incomes and military education.

“America has a mental health crisis. If we want to save lives, protect families and preserve the future, we must rethink our mental health system and take concrete steps to ensure that citizens can get help when they need it,” said CVN President and CEO Dr. Anthony Hassan. A vast majority of Americans (76 percent) believe that mental health is as important as physical health, while 74 percent do not consider such services accessible to everyone, a CVN survey found. “This study confirmed what we hear every day — people are struggling to find the help they desperately need,” said Linda Rosenberg, president and CEO of the National Council for Behavioral Health.

Unsuccessful parity

In 2008, the US Congress passed the parity law, which requires insurance to cover the treatment of mental disorders and addictions in an amount comparable to the treatment of physical diseases. It was helped to push through by former Rhode Island congressman Patrick Kennedy, who became famous on May 4, 2006 for crashing his car on Capitol Hill. The day after the accident, he held a press conference and spoke about the depression and drug addiction that haunted him all his life, promising to begin treatment. The law was enacted at the height of the 2008 financial crisis, attached to an emergency bill aimed at bailing out bankrupt US banks. “The good news is that we have passed the law. The bad news is that no one noticed that we passed it, because even the main bill was secondary to the fact that we were facing a potential Great Depression,” Kennedy said at the time.

Not enough beds

Psychiatrists accuse insurance companies of deliberately delaying payment. “I spoke on the phone for 45 minutes. Told the insurance company rep how my patient got to the emergency room. He explained that he was so depressed that he could hardly walk. But they didn’t want to authorize the payment,” recalls psychiatrist Brian Barnett. As he specified, the patient with deep depression tried for months to use the insurance, but without success. According to him, this is a systematic approach. Barnett argues that many insurance companies are reluctant to pay for mental health services, resulting in nearly half of psychiatrists not accepting insurance at all. According to a report by the consulting company Milliman Inc., patients are forced to pay extra for mental health care out of pocket much more often than for other types of medical care.

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An initial visit to a psychiatrist, according to the report, is paid by insurance on average 20 percent less than an examination by a general practitioner. A number of specialists have chosen to lower their rates instead of working with insurance companies. “Often we just ask the patient how much they can afford and do our best to find a suitable option,” says Dr. Laura Chakes, founder of the Center for Mindfulness and Behavioral Therapy in St. Louis. According to her, the spread in the price can be from 10 to 120 dollars per hour. Kayleigh Place of Shifting Tides Therapeutic Solutions also said she does not accept insurance but is willing to provide cheaper sessions.

Photo: Jose Jimenez / Getty Images

Meanwhile, psychiatric clinics are reducing the number of places due to low compensation from insurers. Even if hospitalization is approved, patients often have to wait for a hospital bed to become available. Usually, the waiting time is about four hours in the emergency department, but in the case of psychiatry, this period increases to several days - until a hospital is found that still has space. A study published in the American Journal of Preventive Medicine found that the majority of counties outside metropolitan areas (65 percent) did not have a psychiatrist, and nearly half of counties in rural areas (47 percent) did not have a psychologist.

Yet, according to a 2015 report from the American Academy of Medical Colleges, more than 60 percent of practicing psychiatrists are over 55 and about to retire—one of the highest rates of any profession. According to the forecasts of the US Department of Health, by 2025, the shortage of mental health professionals will be 250,000 people from the projected need. According to HR firm Merritt Hawkins, the shortage of psychiatrists will be the biggest shortage the labor market has ever faced. “Historically, demand for psychiatric treatment has been low due to stigma. Now the stigma is decreasing, people are ready to be treated, but the supply is still lagging behind, ”explained Dr. Jerry Halverson, chief medical officer at Rogers Behavioral Health.

Avalanche of lawsuits

Americans are trying to get affordable treatment through the courts. There are so many who want that Meiram Bendat opened a legal practice related only to denials of mental health care. Due to the influx of clients, he says he prefers to combine claims into class actions. One of Bendat's most famous cases was a class action lawsuit against United Behavioral Health, a division of the UnitedHealth Group. Didi Tillitt, the mother of Max Tillitt, who was recovering from heroin addiction, was involved in the case. However, the insurance company refused to pay for his treatment at the clinic - a week after discharge, the young man died of an overdose. Didi Tillitt soon realized that this was not an isolated case - across the country, people faced obstacles to help that could save their lives.

Max Tillitt

Photo: Max Tillitt's Facebook page

Related materials:

own) and refusal to pay for treatment. But at the same time, no penalties were taken against the company. “Essentially, they were motivated to keep doing the wrong thing because they realized they weren’t going to be punished in monetary terms,” says Bendat.

Labor Minister Alexandre Acosta also told the Opioid Crisis Commission that "he needs the power to fine violators and conduct individual investigations into insurers, not just clinics. " So far, law enforcement practice suggests that it rarely comes to fines. The best things are in California. There, in 2013, Kaiser Permanente was fined $4 million for violating parity in care, the highest amount in such cases. More often, the courts are limited to orders to correct the shortcomings. For example, CVS Health Corp. simply agreed with the Massachusetts Attorney General to redo the catalogs and give consumers the correct contact information for doctors. In Florida, Indiana, and Nevada, no action was taken by the authorities to force insurers to comply with the parity law.

Patients and their relatives believe that if the courts are led by big business, the government needs to show political will and finally provide access to the promised treatment, on which a person's life depends. The measures that were taken at the state level were not enough to stop the increase in deaths. So far, in the confrontation between people with mental disorders and multi-million dollar businesses, insurance companies are convincingly winning.

let's talk » STATE AUTONOMOUS HEALTH INSTITUTION OF THE KOMI REPUBLIC » UKHTA DENTAL POLYCLINIC

Campaign Brief

Celebrated each year on 7 April, the founding day of WHO, World Health Day is a unique opportunity to mobilize action on a health issue that concerns people around the world.

World Health Day 2017 campaign theme will be depression.

Depression affects people of all ages, all population groups and in all countries. Depression causes mental distress, negatively impacts a person's ability to perform even the simplest daily tasks, and can sometimes be disastrous for a person's relationships with loved ones and friends, as well as a person's ability to earn a living. In extreme cases, depression can lead to suicide - today the second leading cause of death among people aged 15-29years.

However, depression is preventable and treatable. A deeper understanding of what depression is and how it can be prevented or treated will help dispel the negative stereotypes associated with depression and encourage more people to seek help.

This guide is for you

If you are reading this guide, you might also be interested in becoming a campaigner. This is great, because we need your support to achieve the goals of the campaign.

Whether you work for government, an NGO or the media, whether you are a doctor, teacher, journalist, blogger, parent, or just someone who has heard about the campaign and would like to get involved, this is guide for you.

What we want to achieve

The overall goal of this one-year campaign, which will be launched on World Mental Health Day 10 October 2016, is to get as many people with depression as possible in all countries to apply for help and get it.

More specifically, we want to achieve the following goals:

the general public will have a better understanding of depression, its causes and possible consequences, including suicide, as well as what types of help exist or can be available to prevent and treat depression;
people with untreated depression decide to seek help;
family members, friends and colleagues of people with depression will be able to support them.

What is depression?

Depression is an illness characterized by a persistent state of despondency and loss of interest in activities that would normally bring satisfaction, as well as an inability to do daily activities for at least two weeks. In addition, people with depression usually have several of the following symptoms: lack of energy, decreased appetite, drowsiness or insomnia, anxiety, decreased concentration, indecision, restlessness, feelings of worthlessness, guilt or despair, and thoughts of hurting oneself harm or suicide.

Central element of the campaign

The focus of the campaign is on the importance of discussing the problem with the patient as an essential condition for recovery. Around the world, negative stereotypes associated with mental illness, including depression, continue to prevent people from seeking help. Discussing depression with a family member, friend, or health care professional; in larger groups of people, such as at school, in the workplace and at social events; in society, in the news media, blogs or social networks, all help to break down negative stereotypes and encourage more and more people to finally seek help.

Motto

Campaign motto: "Depression: let's talk."

Who is our target audience

Anyone can get depressed. Therefore, our campaign is aimed at every person, regardless of age, gender or social status. At the World Health Organization, we have decided to pay special attention to the three populations most affected by this problem to a much greater extent than others: young people aged 15-24 years, women of childbearing age (especially young mothers), and older people (over 60 years). On the occasion of the campaign, information materials were prepared especially for these categories of the population.

Campaign messages

Depression is a common mental disorder that affects people of all ages and social groups in all countries of the world.
The risk of depression is exacerbated by poverty, unemployment, life events such as loss of a loved one or breakup of a relationship, physical illness, and alcohol or drug problems.
Depression causes mental distress, affects a person's ability to perform even the simplest daily tasks, and can sometimes be disastrous for a person's relationships with loved ones and friends.
Learn more