But what most Georgians need to know is what is called “parity”, says Kaleb McMichen, a spokesman for Speaker David Ralston, who was a key legislative aide. This section of the law mandates that insurance companies cover mental health care in the same way they do physical care. Drug and addiction treatment should be treated in the same way as physical therapy.
Here’s an example of how it should work: say an insured has unlimited doctor visits for a chronic illness like diabetes. Then, under the law, the system must also provide unlimited visits for mental illnesses such as depression or obsessive-compulsive disorder.
Getting into the weeds of the new law
The new law went into effect on July 1. By that date, insurance companies must provide care that is “medically necessary.” But it’s important to point out that this is nothing new, says Roland Behm, board member of the Georgia Chapter of the American Foundation for Suicide Prevention.
The state law already requires that most health insurance plans cover mental health and substance abuse the same way as other health care. But many companies find ways to circumvent the law.
The new law in Georgia defines what is “medically necessary” to include “acceptable standards of mental health or substance abuse treatment,” so there is no gray area.
The new law gives less leeway for insurance companies to deny mental health treatment out of hand. The new law favors the decision of the psychiatrist treating the patient.
If an insurance company wants to deny psychiatric treatment, the denial must be based on standards recognized by psychiatrists, not guidelines made by the insurance company or its substitute.
How can a person be sure that their mental health is being treated the same as their physical health?
The biggest change that Georgia’s insurance policyholders should expect to see now is insurance companies offering more psychiatric and substance abuse services. But this may take time, and Georgia citizens may need to appeal to the government to help make changes.
There will be several “red flags” that an insurance company is not following the new law, says Eve Byrd, director of the Carter Center’s Mental Health Program. This includes, but is not limited to:
– One cannot find a psychiatrist who is “in-network,” which is where the insurance company pays for the treatment.
– The number of medical treatment or visits for treatment of drug addiction or drug use is low while other health visits are not low.
– A person must call and get permission to receive medical care, but not for other medical services.
Are there ways or means that insurers can try to deny this coverage that Georgia residents should look into?
Byrd, of the Carter Center, said he should look into the suspension because it is “not medically necessary,” especially when a psychiatrist is recommending that the treatment is needed.
If I’ve been receiving medical care but I’m paying for it myself, what do I need to do to get insurance?
The answer is to do more, says Behm, who works for the Georgia Chapter of the American Foundation for Suicide Prevention.
First, check if your provider is online. If the provider is not in network, then find in-network health care providers, and ask them to see if they are accepting new patients.
If you can’t find an agent that works, contact the insurance company and ask them to find an agent. Another option is to ask the insurance company to consider a one-size-fits-all contract, which would cover essential medical services if the provider is in the network.
If the company fails to transfer you to another company or to give you a one-issue contract, proceed to file a complaint with the government.
What recourse can a Georgia insured have if the law is not followed?
First, call your insurance company and dispute any denials of care or unexpected charges. While doing this, carefully keep a record of every communication with the insurance company related to the dispute, such as writing down the name of the person you spoke to, the date of the call and a summary of the conversation you had.
If you can’t reach a settlement with your insurance company, file a claim against your private insurer Consumer Services Division within the state’s Office of the Insurance Commissioner.
Those complaints can be filed online now. There are clear instructions on how to file a complaint.
For Medicaid enrollees, there is an internal appeal process that is unique to each Medicaid plan. If a person is not happy with the decision, they can appeal with a Office of State Administrative Hearings.