New tools help measure how well insurers are covering mental health

Caption

Gov. Brian Kemp (right) shakes the hand of late House Speaker David Ralston after signing House Bill 1013, the Mental Health Parity Act, into law on April 4, 2022.

Credit: Riley Bunch / GPB News

Parity laws require health insurers to cover medically necessary physical and mental health care equally.   

In Georgia, Medicaid programs and the State Health Benefit Plan are expected to abide by House Bill 1013, passed unanimously by the legislature in 2022. All other insurers fall under the purview of federal parity laws.  

A couple new tools can help consumers navigate how well their own insurers are doing with parity, as years later, analysis suggests many insurers are still falling short on vital metrics.  

The parity dashboard from Georgians for a Healthy Future covers Medicaid and commercial marketplace plans.  

Whitney Griggs with Georgians for a Healthy Future said what’s partially behind the "F" grades assigned to some insurers is that they’re not providing real-world data on consumer experiences, what Griggs calls "operation parity."

"What they don't show you is the experience of the consumer trying to get that mental health care," Griggs said. "How hard is it for them to actually find a provider in their area? And that is measurable, and something that, until we have that information, we'll never really know how consumers are fairing with the mental health parity law."

As far as commercial marketplace plans go, there’s even more information missing, Griggs said. Most private insurers in Georgia — including companies such as Cigna, Oscar and Blue Cross Blue Shield — do not follow standard templates for reporting.  

That makes it difficult to understand how coverage is applied to mental or behavioral health care, or why care may not receive prior approval.

Setting standards to measure outcome

Without a standard reporting scheme or even definitions for what medically necessary care is, it’s difficult to hold insurers accountable.  

"The plan gets to kind of play this inside baseball on how it's going to decide to cover," Griggs said. "And now the person who needs care can't get care covered."

Over a dozen Georgia insurers were fined millions this year by the state for parity violations. A bill that would have increased fines for such violations did not pass the legislature before the end of this year’s session.  

Parity complaints can be filed on the Georgia’s Department of Community Health website.

One organization setting a standard definition for mental health parity is The Kennedy Forum.  

According to its Mental Health Parity Index, there are only a handful of states that come close to meeting parity standards. 

The Index uses pricing and coverage information published by health plans to measure insurers' parity compliance. For example, counties with a better ratio of physical and mental health care providers in-network are considered to have better network compliance.  

"What this tool does is allow people to be able to start this conversation so that they can start looking for those practitioners, the clinicians, the providers that are in the area," said Michelle Quist Ryder, CEO of the American Psychological Foundation, a partner on the project. 

In Georgia, the majority of counties fall either within compliance with these parity standards, or just outside of it.  

Nathaniel Counts is the chief policy officer at the Kennedy Forum.  

"If there are ghost networks, then the disparities you see between the in-network providers would actually be quite a lot larger because functionally, as you said, the number of in-network providers would be even less," Counts said.  

The index shows active contracts between providers and health plans, but billing information is private.