mental health coverage

[free4me]

What is the name of your state? Pennsylvania

My employer cut mental health coverage for 2004 50%, to 30 visits total - inpatient/outpatient, whatever. Pennsylvania mental health parity law mandates coverage of 30 visits yearly for 'non-serious' diagnosis & 60 yearly for 'serious'.

My employer states that because they are self insured/self funded that they are exempt from state law. I have contacted state offices/federal offices/local political representatives/mental health advocacy groups and gotten no help at all with this. I've offered to waive other coverage in order to maintain the higher nbr of visits, but they will not make any concessions.

My employer tells me to talk with a case manager at the insurance company - that they are supposed to help work out resolutions to this type of issue. The insurance company tells me that they go strictly by what the employer says and can do nothing.

Any ideas from anyone on possible ways to pursue this issue? I'm not willing, at least not yet, to take no as a final answer on getting more visits.

thanks for any input.

 

[Beth3]

Your employer is correct in stating that their self-funded group health plan exempts them from most state and federal mandates requiring certain levels of coverage, which typically only apply to insured plans.

Take a look at the Mental Health Parity Act (should be easily researched via the internet.) It's been a while since I reviewed that but I suspect it also only applies to insured group plans.