Parity means “Relief” For Many Insured  Who Seek Psychotherapy

In January 2001, a new law went into effect in California, making certain mental health diagnoses “equal” to physical diagnoses, in terms of reimbursement.  This comes as good news to many individuals who have effectively been denied adequate treatment in the past due to a much reduced mental health benefit policy. 

The individuals who will benefit from this change will include those with “more serious” mental health diagnoses.  A higher benefit level will be paid to those with diagnoses such as Schizophrenia, Manic-Depression, Autism and Anorexia Nervosa.  But disorders such as Dysthymia (a form of chronic depression), Major Depression, Bulimia, ADHD, Panic Disorder, and Obsessive-Compulsive Disorder will receive the higher benefit as well.  Together, these diagnoses represent a large proportion of those who consult mental health specialists.

The parity benefit impacts therapy seekers in two ways.  With Managed Care, the short-term emphasis and tight control on the number of sessions is relaxed.  Patients can receive longer-term psychotherapy as opposed to being seen for perhaps 15 sessions before being dropped.  With “standard indemnity” insurance, such as Blue Cross, the deductible is often dropped, and the co-pay is reduced considerably.  This often allows a patient to seek treatment for the first time, because the cost isn’t overwhelming!  Contrast a typical Blue Cross plan where the deductible is $250. or $500., and the plan pays only $25 toward each session with a parity situation where there is no deductible and a $20. Co-pay.  (Many people cannot afford a weekly cost of $66.20---the difference between $25 benefit and the $91.20 charge allowed to psychologists by Blue Cross).

So this is indeed good news for people who want to pursue psychotherapy.  Now might be the best time  yet to “take the plunge” and inquire about therapy.

Marc Wilmes-Reitz, Ph.D. is the Director of Wilmes-Reitz Psychological in Calabasas.  He can be reached at 818.591-8270

11/16/2002