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AUDIE CORNISH, HOST:
The federal mental health parity law was supposed to protect patients from discrimination by insurance companies. But in the seven years since it was passed, the U.S. government has not taken a single public enforcement action against an insurer or employer for violating the law. And some patients still find it difficult to get the mental health treatment they need. Jenny Gold has this story of a father who is suing his insurance company over the treatment given to his son.
JENNY GOLD, BYLINE: Michael Kamins remembers when he first opened the letter from his insurer in 2012.
MICHAEL KAMINS: When I got that letter, there was steam coming out of my ears. This is my kid’s life. This is my kid’s well-being.
GOLD: According to his lawsuit, his 20-year-old son had attempted suicide a year before as a freshman at an Ivy League college. Since then, he’d been diagnosed with bipolar disorder and hospitalized twice; most recently just a few months before. He thought his son was getting better, but now, his suit alleges, the insurer was cutting his son’s visits with the psychiatrist to just twice a month.
KAMINS: I’m seeing progress and what do they tell me? Oh, no, you can’t have 13 sessions. You can only have two.
GOLD: Kamins and the psychiatrist filed several appeals to the insurer Optum, which is a subsidiary of United Health Group, but they were denied. Eight months later, his son was back in a psychiatric ward, according to the lawsuit.
KAMINS: I’ll make the analogy of somebody drowning who finally gets to the surface of a lake. His head comes out, he gasps for air, and what does Optum do? They shove him down again.
GOLD: Kamins, who’s a professor in New York, decided to sue. The federal parity law is supposed to guarantee people with mental illnesses the same access to treatment as patients with diseases like cancer or diabetes. And most insurers have dropped the higher copayments and separate deductibles they used to charge for mental health. But Kamins’s lawyer, Meiram Bendat, says some insurers have continued to limit treatment in subtle ways.
MEIRAM BENDAT: Insurers have become much more crafty at finding protocols that are not expresed numerically that are more difficult to spot.
GOLD: For example, the lawsuit alleges that Optum required Kamins’s son to get prior authorization to see his psychiatrist, something not required for other kinds of illnesses. And the insurer claimed his visits weren’t medically necessary, despite the psychiatrist’s orders, according to the complaint. The federal law doesn’t allow people with insurance plans like Kamins’s to bring private lawsuits to enforce it. So instead, he had to sue under New York state law. Optum would not comment on the specifics of the case and has asked that the suit be dismissed. But Bendat says the real problem is that state and federal governments aren’t doing enough.
BENDAT: The implementation and enforcement of parity has been rather lacking across the board.
GOLD: But Clare Krusing disagrees. She’s a spokeswoman for America’s Health Insurance Plans – the industry’s main trade group.
CLARE KRUSING: The idea that there is limited enforcement of mental health parity is a misperception.
GOLD: Krusing says insurers are working behind the scenes with federal and state agencies to make sure they’re providing proper mental health coverage. But that isn’t easy.
KRUSING: It’s not a math formula. A treatment plan for diabetes or a chronic heart disease is very different from a treatment plan for a patient that’s seeking care for depression or another mental illness.
GOLD: Especially when insurers are also trying to hold down costs by preventing unnecessary care, she says. Former Congressman Patrick Kennedy helped write the parity legislation. He describes the government’s enforcement record as slow and sparse, and he says the timing of the Affordable Care Act is partly to blame.
PATRICK KENNEDY: The parity law kind of got kicked down the tracks until the Obama administration could get the ACA on track.
GOLD: And he says enforcing the laws against insurance companies has been delicate politically.
KENNEDY: Insurance companies were part of the coalition that helped bring the ACA to life. And so the administration feels an enormous debt of gratitude to insurers. So it’s a challenge politically to then step on the toes of those that brought them to the dance.
GOLD: Since 2010, the Department of Labor, which is the main federal agency in charge of parity, has found 140 instances in which a patient’s parity rights were violated. A spokesman for the department says all those issues were resolved voluntarily, but no insurer has been fined, and none of the results are public. Carol McDaid, of the Parity Implementation Coalition, says that’s made it difficult for advocates like her to help other consumers.
CAROL MCDAID: Our problem with that that these investigations are all kept secret. They’re not putting it on a website. They’re not releasing it to us.
GOLD: She says few patients even know they have legal protection. Michael Kamins is one of just a handful of consumers to bring a lawsuit, a costly and time-consuming endeavor. He says he owes it to his son.
KAMINS: I’m his dad. I do love him. He’s a wonderful kid. He’s a wonderful kid and I’m going to give him every opportunity to achieve everything that he can achieve, you know? And I think any father would do the same.
GOLD: His lawsuit is still pending. Meanwhile, the family has a new insurance company, which, so far, has given his son more access to treatment. Now 23, he’s doing better and is scheduled to graduate from college next year. For NPR News, I’m Jenny Gold.
CORNISH: Jenny Gold is with our partner, Kaiser Health News, a nonprofit news service.
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