Insurers Must Cover Mental Health Treatment Under California Ruling

Mental Health Insurance Industry News

June 10, 2012

A recent ruling by the Ninth U.S. Circuit Court of Appeals will help Californians who need treatment for mental health issues to get the insurance coverage that they need. The decision will hopefully help eliminate health care claim disputes for individuals struggling with depression, anorexia or other mental health issues.

The ruling was the result of a case that involved a woman who had been battling anorexia for about 20 years. When her doctor suggested that she undergo treatment at a facility that specializes in eating disorders, her insurance company, Blue Shield, agreed to pay for her care. However, the company later refused to pay for the treatment, even though California’s Mental Health Parity Act says that treatment for severe mental illnesses must be covered by insurers.

When the woman sued Blue Shield, the insurance company claimed that it didn’t have to pay for her treatment because residential facilities were not covered under the parity law. The court, however, disagreed and sided with the woman. After the ruling, Blue Shield asked the Ninth Circuit to rehear the case. The court declined, leaving Blue Shield responsible for paying for the woman’s medical bills.


What Is the Mental Health Parity Act?

Suffering from a mental health challenge is difficult enough, but when patients are worried about paying for the treatments that they need, it can make these problems exponentially worse. The California Mental Health Parity Act helps to alleviate some of these concerns because, under this law, insurance companies must provide the same coverage for the treatment of mental illnesses that they would provide for the treatment of physical illnesses. The law applies to insurance plan benefits such as medication coverage, deductibles and copayments.

Some other features of the law include:

  • Illnesses – The illnesses covered under the parity law include anorexia, bulimia, major depression, schizophrenia and obsessive compulsive disorder.
  • Types of care – The mental health care that can be covered by law include things like individual or group counseling, diagnostic tests, prescription drugs and hospital visits.
  • Types of providers – Patients can see several different kinds of mental health professionals under the parity law, including psychologists, psychiatrists, psychiatric nurses, social workers, neuropsychologists, and marriage and family therapists.

The Mental Healthy Parity Act is designed to give people the peace of mind of knowing that their claims should be covered. Individuals shouldn’t have to worry about having their insurance claims denied.

Unfortunately, insurance claims disputes still arise. Insurance companies still deny claims or delay making payments hoping individuals will accept their position and give up. There are other options. If your insurance claim has been denied and you are entitled to coverage, you should speak with an aggressive Los Angeles insurance claim lawyer who can help you protect your rights.