Legalized Discrimination: BPD and Health Insurance

Regardless of who wins this year's elections, I am nervous. Health insurance reform hangs in the balance. If you ask me why I'm worried about that, it's because health insurance as it currently stands has a legalized discrimination policy when it comes to mental illness, especially ones like borderline personality disorder (BPD). There are two ways the discrimination is encoded: in pre-existing conditions clauses and lack of mental health parity.

Pre-existing conditions

One of the provisions of the Affordable Health Care Act is the elimination of pre-existing conditions clauses in 2014. Regardless of who wins, we need this part of the act to stay. Pre-existing condition clauses are ways for insurance companies to get out of paying for expensive mental health care.

I can't get health insurance because of my psychiatric status; it's a pre-existing condition. As a result, I stay on Medicare and Medicaid so I can get mental health treatment. To do this, I have to stay on Social Security Disability so my income doesn't exceed the low limits (in Indiana, it's $1,500). This forces me to stay in poverty and costs the taxpayers money that could be better spent elsewhere.

It is my hope that when the pre-existing condition clauses are abolished, I can return to the workforce and secure insurance through my employer--insurance that covers my mental health condition without regard to how long I've had it or whether I've had a lapse in coverage.

Lack of mental health parity

Parity means that mental illness can not be treated differently than more traditional physical illnesses. Sadly, there are loopholes that need legislative action.

“Parity for mental health and addiction treatment has been an uphill battle," writes Gina Eckhart of Midtown Community Mental Health Services. "Most insurance companies do not offer extensive coverage for outpatient care, requiring co-pays of 50 percent or more and limited visits. This is, of course, very different form the standards for visits to primary care physicians and other healthcare specialists. Someone suffering from severe mental illness will often require frequent visits with both a psychiatrist/clinical nurse specialist and a therapist. … Many private insurance companies have been unable or unwilling to credential mental health centers rather than individual practitioners, making it difficult for consumers to find a provider that the insurance company will reimburse. Case management services are often needed for clients with mental illness to ensure follow-through on other healthcare needs, provide transportation to and from treatment, obtain assistance getting prescriptions filled, and ensure they have access to other benefits. Case management services are not generally covered by private insurance.”

The Mental Health Parity Act of 1996 did not entirely alleviate the problem. According to the Centers for Medicare and Medicaid Services, the act prevents insurance companies from offering lower mental health benefits than physical health benefits—for example, if a health plan has a $1 million lifetime cap for medical and surgical benefits, it can not cap mental health benefits at $100,000. However, there is no prohibition against increasing co-pays or limiting visits, imposing limits on the number of covered visits even if there is no comparable limit in medical or surgical benefits, or having higher co-pays for mental benefits than physical or surgical benefits. In addition, if meeting the MHPA’s requirements would increase the employer’s costs by one percent or more, they are exempt. Employers with less than fifty employees are also exempt. In addition to this, there was no requirement mental health benefits were offered.

So how does BPD factor in?

BPD is a severe mental illness that insurance companies don't like to cover. When I had private insurance through a restaurant job, my coverage was limited to 20 outpatient visits and 30 days of inpatient care. A person with BPD will need considerably more than 20 outpatient visits, and depending on the severity of his/her case, may need more than 30 days of inpatient care.

BPD may also require case management services such as the assistance of an ACT Team. For example, I have someone administer medication to me instead of taking it myself because I forget to take it otherwise. Also, I live in a supported apartment, with a payee managing my disability checks. I don't know of a private insurance plan that would cover these two services.

Life with BPD is hard enough. The legalized discrimination of health insurance just makes it harder. We need to abolish pre-existing conditions and establish true mental health parity!