A bill in the Georgia House is aimed at bringing insurance coverage for behavioral health issues in the state up to par with the rest of the country. GPB’s Ellen Eldridge reports.

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A bill in the Georgia House is aimed at bringing insurance coverage for behavioral health issues in the state up to par with the rest of the country.
Credit: Photo by Alex Green from Pexels

Thirteen years ago, Congress passed a so-called coverage parity law saying treatment for substance use and mental health issues should be covered by insurance just like asthma or diabetes. 

The Mental Health Parity and Addiction Equity Act of 2008 generally prevents group health plans and health insurance issuers that provide mental health or substance use disorder benefits from imposing less favorable limitations on those benefits than on medical/surgical benefits.

California's legislature in 2020 passed one of the nation's strictest mental health parity bills. It aims to increase mental health insurance coverage to include far more conditions — including, notably, addiction — as well as redefining the criteria for insurance denials, NPR previously reported.

But behavioral health care advocates here say Georgia has not kept up. 

Ten years after the federal law was passed, Georgia received a failing grade for behavioral health parity, according to a 2018 report produced in collaboration with the Morehouse School of Medicine, The Kennedy Forum and WellBeing Trust.

Laura Colbert, with Georgians For a Healthy Future, said one clue that parity is not working is how often behavioral health is not covered by Georgia insurance plans. She spoke about mental health parity during a Wednesday town hall meeting hosted by the Georgia Council on Substance Abuse.

"Georgia families are forced to navigate a really confusing insurance system in the middle of what might be a substance use crisis or a mental health crisis," Colbert said. "You may be denied coverage for substance use services because the insurance company says they're not 'medically necessary.'"

Often, though, insurance companies don't explain to the insured why services aren't deemed medically necessary.

Another way parity issues can show up is being unable to access early treatment that can help prevent issues later.

Colbert said they want to identify issues before they get to crisis level, especially with substance abuse.

"And sometimes insurance companies ... won't let you have those early services that can prevent crises,"  she said.

Georgians are almost 10 times more likely to have to go out of network for care, which is much higher than the national average, Colbert said.

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The Carter Center's program director, Eve Byrd, said Georgians are four times more likely to have to go out of network for an office visit for behavioral health services, as compared to primary care.

“By simply talking to friends and colleagues, you will hear how common it is for people to struggle to get a family member the help they need covered by their insurance plan, from an in-network provider within a reasonable distance,” Byrd said.

Part of the problem, Colbert said, is the stigma associated with behavioral health care.

When a child suffers asthma attacks and has to visit the emergency room and use an inhaler, the insurance company rarely questions the medical necessity, but that isn't the case with substance use disorder, Colbert said.

"Substance use and addiction are chronic, treatable diseases and they need to be treated just like other chronic treatable diseases," she said.

Those with private insurance are encouraged to report complaints to the Georgia Department of Insurance and those with Medicaid can complain to the Department of Community Health.

"Our state leaders and our federal leaders are not going to fix it if they don't know there's a problem," Colbert said. "And we want there to be a systemic fix so that families don't have to deal with this in the first place."

House Bill 49, sponsored by Snellville Democrat Shelly Hutchinson, is aimed at making these parity violations less common.