Understanding Parity and Behavioral Health Coverage in Ohio

Mental health is an essential aspect of overall well-being, yet navigating the complexities of healthcare coverage for mental health services can be daunting. Despite the growing awareness around mental health and addiction, there remain numerous misconceptions about what coverage exists in Ohio and how it works.

Our goal is to help you explore the critical role of parity in behavioral health coverage, common misconceptions, and the importance of advocating for yourself. Teresa Lampl, CEO of the Ohio Council of Behavioral Health and Family Services Providers,[1]  also shares valuable insights into the current state of mental healthcare in Ohio and the crucial changes needed to improve access to care.

What Does “Parity” Mean in Healthcare Coverage?

One of the key concepts in healthcare that is frequently addressed is the idea of “parity,” especially when it comes to behavioral healthcare. In healthcare, this concept refers to ensuring that mental health and substance use services are covered equally to medical and surgical care. This means insurance providers should not impose stricter limitations or higher costs on behavioral health services than they do on other forms of healthcare.

Despite its importance, achieving true parity remains a challenge. Disparities in coverage persist, especially in certain programs where parity laws don’t apply, such as Medicare. These gaps leave many individuals struggling to access the care they need. Additionally, even where parity should be enforced, some insurance plans fall short, creating barriers like limited provider networks or unclear processes for approval and reimbursement.

We stress the importance of understanding your rights when it comes to healthcare coverage. If you experience challenges accessing behavioral health services, knowing what parity means can help you advocate for the care you deserve.

The Role of the Ohio Council in Behavioral Health

The Ohio Council plays a vital role in advocating for improved mental healthcare access and quality across the state. As Teresa Lampl explains, “The Ohio Council is a statewide trade and advocacy organization. We represent about 170 community mental health, substance use, and family service provider organizations. What we do is create public policy and provide advocacy work to make sure that there is a regulatory environment that ensures Ohioans have access to high-quality services, whether they are seeking mental health or addiction treatment.” This advocacy work is crucial to ensuring that individuals with mental health and substance use conditions receive the care they need.

The Ohio Council works at both the state level and within local communities to address the growing need for mental health services, ensuring that resources and funding are appropriately allocated to meet this demand. Their advocacy efforts often focus on improving the availability of services, reducing stigma, and pushing for legislative changes that make mental healthcare more accessible.

The Personal Touch: Inspiring Change

Teresa’s personal experiences with family members who have struggled with mental health issues have deeply influenced her career path. “I guess I’ve always been a person who was a natural helper,” she shares. “Experiences that I couldn’t define at the time as living with family members that experience mental health conditions helped me believe that these conditions are highly treatable. People can get well, recover, and live full and fulfilling lives.” This personal connection fuels her passion for advocating for a more equitable and supportive system for individuals with mental health needs.

Common Misconceptions About Healthcare Coverage

A common misconception that Teresa encounters frequently involves confusion around what behavioral healthcare coverage actually includes. Many people assume that if they have insurance, they’re automatically covered for mental health services. But in reality, that’s often not the case. Even if someone has insurance, it may not cover all behavioral health treatments, or it might impose limits on how many visits are covered.

Another issue is the lack of clarity about whether certain providers are covered, especially when it comes to specialized care. People don’t always realize that seeing a specialist in the behavioral health field may not be covered under their current plan. “Sometimes, people end up paying out of pocket for services that they should have access to,” she explains.

Another assumption she addresses often is that mental health services are easy to access. Many individuals make incorrect assumptions about their mental health coverage. “I think this is one of the places where, in the healthcare market, most of the time providers prefer plans other than Medicaid,” Teresa explains. “Because if I’m treating your heart, your blood, your bones…the commercial payer is a better payer. It’s more comprehensive, higher rates. It’s better than Medicaid almost universally. The exception to that is behavioral health.” This highlights the difficult situation where Medicaid often provides more comprehensive mental health coverage than commercial insurance plans.

Recent Changes to Healthcare Coverage in Ohio

Significant changes are underway to improve mental health coverage in Ohio. “Starting this year, insurance companies have to actually show their work,” Teresa states. “They have to provide a more comprehensive report where they provide the data that supports and justifies their work.” This increased scrutiny of insurance companies is a crucial step towards ensuring compliance with parity standards. Additionally, establishing the Mental Health Insurance Assistance Office (MHIA) provides a valuable resource for consumers to navigate coverage questions and seek assistance with accessing care.

However, Teresa also emphasizes the critical role of consumer advocacy: “The whole system around enforcement is based on consumer complaints. So if we don’t complain about what’s happening, then we don’t create a record of what’s broken.” Actively engaging with insurance companies, advocating for one’s self, and filing complaints when necessary are crucial steps in ensuring access to quality mental healthcare. It’s essential for individuals to be their own advocates when it comes to accessing mental health care. “If you’re not getting the coverage you need, don’t be afraid to fight for it. There are resources out there to help you navigate this process.”

Understanding healthcare coverage – especially behavioral health coverage – is essential for anyone seeking mental health or addiction services, or seeking it for their family members. With the recent changes in Ohio’s healthcare system there is hope for better access to care, but individuals must remain vigilant about their coverage. By staying informed and knowing your rights under parity laws, you can better navigate the complexities of healthcare coverage and ensure that you receive the care you need.