CommunityHealth

Texans Get Help Accessing Mental Health Insurance Benefits

Under a little known law that took effect in September 2017, insurance companies may not cover mental health and substance abuse care differently than they cover medical benefits and offer more help for consumers who believe their insurance is wrongly denying them coverage.

Rep. Four Price, R-Amarillo, chairman of the House Public Health Committee, and author of House Bill 10, said during the last legislative session that the bill gives the Texas Department of Insurance more power to enforce how health insurance plans offer mental health and substance abuse benefits. He said that insurance companies are offering mental health and substance abuse benefits but that Texans currently have nowhere to turn to in the state when problems arise. “Folks are paying for coverage; they’re just not able to access adequate treatment,” Price said.

Under the new law, insurance companies offering mental health and substance abuse care benefits would not be allowed to make such coverage different than how medical benefits are covered. Price said the bill was not meant to expand insurance coverage for mental health services. In the past, patients who wanted more care or counseling services either had to seek individual approval or pay out of pocket.

The bill came as both chambers aim to overhaul how Texas gives access to services and cares for mental health patients. The 2010 Affordable Care Act classified mental health and addiction services among the essential health benefits that must be covered by small and individual plans, without annual or lifetime caps on benefits. The law built upon 2008 federal legislation that called for large group plans to offer mental health benefits on par with other medical coverage.

Days before the legislative session started in January 2017, the Select Committee on Mental Health released its findings from eight hearings in a report saying that if Texas lawmakers didn’t take bolder steps to fix the state’s mental health system, they do so “at our own peril.”

Some of the recommendations included giving the Texas Department of Insurance more power to investigate behavioral health plans and enacting a state mental health parity law. The agency received a dozen complaints of alleged mental health parity violations in the past year, and only one was confirmed.

The new law also requires the Department of Insurance to create an ombudsman for behavioral health to help uninsured and insured consumers access mental health services. The ombudsman would also be responsible for tracking and reporting on how insurance companies are stacking up with providing mental health benefits.

Another provision of the legislation would be for the Texas Health and Human Services Commission to create a Mental Health Condition and Substance Use Disorder Parity workgroup under its Office of Mental Health Coordination. The workgroup would be required to recommend how Texas can improve compliance with state and federal statutes on mental health benefits and make it easier for patients to file complaints.

Sen. Judith Zaffirini, D-Laredo, was the author of Senate Bill 860, which was identical to HB 10.

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