[reader1587]

I just got a letter from my health insurance company (Capital BlueCross, for south-central Pennsylvania) saying behavioral health will no longer be covered as of January 1, 2011…I thought the healthcare reforms were supposed to be better for mental health coverage. (I had "comprehensive", paid privately.)

Does anyone have any suggestions? I wouldn't mind something at a national level, if that exists, rather than something tied to a specific region (may be moving).

I tried to figure out from the CapBC website my options, but couldn't make heads or tails of it. I'm going to call them, but I'm not sanguine about the odds of them steering my towards anything other than the higher-priced stuff. I'm not working right now, but don't qualify for any govt programs. Also I've had Dxs of depression/anxiety/adjustment disorder for >10 years, I'm assuming that's a "major pre-existing condition"?

tia

[krisakira]

You can always ask your pdoc about similar meds that are on the waalmart four dollar list. Also to see a pdoc and a therapist, there are many places, usually in bigger cities, ,that offer free or very low cost mental health services for people who are uninsured and have low or no income.

[krisakira]

I don't have an income or insurance, and have found a place that gives me free vistaril, and therapy sessions for life 4 dollars each as well as pdoc sessions for same price. And i get my citalopram for 4 dollars from walmart.

[reader1587]

Originally Posted by krisakira

You can always ask your pdoc about similar meds that are on the waalmart four dollar list. Also to see a pdoc and a therapist, there are many places, usually in bigger cities, ,that offer free or very low cost mental health services for people who are uninsured and have low or no income.

oh i forgot to say i actually don't take my meds

coverage would be entirely for psychotherapy

[krisakira]

Oh ok well it goes for the therapy sessions too then.

[reader1587]

Originally Posted by krisakira

Oh ok well it goes for the therapy sessions too then.

yeah i hear you

i was just interested in something that wasn't free/really low-cost (although i don't have even any experience with it, maybe it's better than i imagine)

hope that doesn't sound snobby

also i will probably be overseas for a while next year

so would see someone out-of-network and mail the bills in myself

[krisakira]

Well dint toss the option k? My low cost/free services have the same kind of psychiatrists and therapists as any other not so free clinic. Just sayin

[googley]

I'm sorry to say, the new insurance laws only apply to group insurance policies, not individual policies. So there are no protections for you in those new laws. I would call them and ask them if there is a way to get it added and how much it would cost. You might want to get quotes from other companies also. Good luck.

[reader1587]

Originally Posted by googley

I'm sorry to say, the new insurance laws only apply to group insurance policies, not individual policies. So there are no protections for you in those new laws. I would call them and ask them if there is a way to get it added and how much it would cost. You might want to get quotes from other companies also. Good luck.

Thanks that clarifies it a lot.

I am going to call them.

Anyone else who's familiar with this part of the country (southcentral/southeastern Penn.) know of any other companies that might have good (better) individual policies that include "behavioral health"?

[ECHOES]

This is how the insurance companies will get around the parity laws.
Parity only applies *if* the policy covers mental health and substance abuse, and applies to plans with anniversary dates 7/1/2010 and after.

The way to get out of this is to drop mental health/substance abuse coverage altogether.

[reader1587]

Originally Posted by ECHOES

This is how the insurance companies will get around the parity laws.
Parity only applies *if* the policy covers mental health and substance abuse, and applies to plans with anniversary dates 7/1/2010 and after.

The way to get out of this is to drop mental health/substance abuse coverage altogether.

ok thanks another good clarification

i guess decision comes down to whether presumably extremely high insurance rate that covers mental health is worth it vs. paying out of pocket with no coverage for psychotherapy

[Skully]

If the are dropping the mental health coverage, they should still cover the medications you are taking because they are not dropping the prescription coverage. Regardless of what you are taking and for what, they should cover it.

[reader1587]

Originally Posted by Skully

If the are dropping the mental health coverage, they should still cover the medications you are taking because they are not dropping the prescription coverage. Regardless of what you are taking and for what, they should cover it.

i don't take any meds right now but thanks

[Perna]

Does this apply to you?

https://www.capbluecross.com/Provide.../MentalHealth/

I would definitely call Capital and find out what's going on; if they're just stopping one and starting another or as Echoes says, they're dropping any coverage for mental health or what.

[reader1587]

Originally Posted by Perna

Does this apply to you?

https://www.capbluecross.com/Provide.../MentalHealth/

I would definitely call Capital and find out what's going on; if they're just stopping one and starting another or as Echoes says, they're dropping any coverage for mental health or what.

Thanks very much I will definitely get off my butt and make the call.

[reader1587]

Originally Posted by Perna

Does this apply to you?

https://www.capbluecross.com/Provide.../MentalHealth/

I would definitely call Capital and find out what's going on; if they're just stopping one and starting another or as Echoes says, they're dropping any coverage for mental health or what.

I will check into what Magellan offers directly.

Btw when I got back from overseas last month there was a letter from CBC saying my behavioral health coverage had been reinstalled for 2011 (and they hoped they hadn't caused me any "inconvenience"!).

Was wondering if maybe it was because I talked to a customer service rep and declined to setup automatic monthly billing because I would need to be switching providers soon anyway.

Regardless the problem has been pushed back at least a year, although I'm going to try to figure something out quicker this time.

Thanks for the CBC/Magellan link

[Can't Stop Crying]

Glad it's straightened out for now...in the future have you considered asking T for a sliding scale fee? Some will, some won't..worth a shot

[reader1587]

Originally Posted by Can't Stop Crying

Glad it's straightened out for now...in the future have you considered asking T for a sliding scale fee? Some will, some won't..worth a shot

I've done that in the past sometimes…ideally the best situation is to have coverage plus a reduced fee…but I have to be more assertive about asking for one in the future.

[Fresia]

If they do this again or you decide to go with a new plan, even though your policy will no longer be covering mental health and probably need it for your other medical anyway, just do not let it lapse before finding another and being covered by it. You cannot be subjected to a preexisting clause with the new policy if you get a "certificate of coverage" letter from your existing company which will help with the transition and ensure you do not get slammed without it, so instead existing diagnoses are covered with the new one.

Glad it was reinstated in the meantime. Good luck finding a new plan if you decide to do so!!

[jaclinhyde]

Originally Posted by reader1587

I just got a letter from my health insurance company (Capital BlueCross, for south-central Pennsylvania) saying behavioral health will no longer be covered as of January 1, 2011…I thought the healthcare reforms were supposed to be better for mental health coverage. (I had "comprehensive", paid privately.)

Does anyone have any suggestions? I wouldn't mind something at a national level, if that exists, rather than something tied to a specific region (may be moving).

I tried to figure out from the CapBC website my options, but couldn't make heads or tails of it. I'm going to call them, but I'm not sanguine about the odds of them steering my towards anything other than the higher-priced stuff. I'm not working right now, but don't qualify for any govt programs. Also I've had Dxs of depression/anxiety/adjustment disorder for >10 years, I'm assuming that's a "major pre-existing condition"?

tia

That truly sucks and I am so sorry that you are going through this. I work (or did considering I haven't been at work now for over 2 weeks due to my bipolar depression) for Humana and can tell you that at least as far as meds are concerned you will probably need a prior authorization from your doc to get them covered. What you might try is having your regular doctor prescribe them and issue the PA. If you fight hard enough and complain loud enough you might just get an exception. Good luck to you!

[kathleen slattery]

Reader, I found your situation to be incredible; that Blue Cross dropped your mental benefit eff. 1/1/11! But you are correct, as I googled their website. The catch 22 here has to do with Federal Mental Health Parity Regulations; which mandate a carrier to provide the same co-pays and levels of service as would be paid to a regular doctor. However, insurance companies are not obligated to offer mental health, and due to the fact that mental health is a financial burden, many companies are dropping the insurance.
Having worked in the health care industry for 20 years (for a union); I can tell you that we dropped Blue Cross many moons ago, due to their limited benefits and exorbitant premiums. Why not shop around; try some new carriers like Aetna Advantage, US Healthcare, or a group based in CA called United Behavioral Health (425 Market St, 27th Fl, San Francisco CA 94105)?
If you google: "Best Mental Health Care Insurance companies to consider", a list comes up. I suspect that this might require you to pay another premium on top of your regular insurance, but perhaps it might not be outrageous. Good luck!

[reader1587]

yes i had called united behavioral health in the fall for some reason i didn't qualify but i will try again

also aetna thanks for the suggestions

Wow I am glad I switched insurances before this happened. I used to have this same exact insurance. Same area. They did do a poor job at mental health services to begin with. They dropped me a week into my eating disorder inpatient stay because the doctor recommended NG removal. Meaning I could eat without a tube. Forget the behavioral stuff, as long as I'm stabilized medically. The hospital felt so bad that they kept me another 3 weeks free of charge.

this website might be helpful. There is a list of all the insurance companies in Pa and their credentials. I know a few people in at my office who work and receive just over a 1,000 dollars a month that are not eligible for mcaid who receive benefits. It's a shame they recently cancelled adultbasic in Pa. Which was basically the CHIP for adults. They have a new one coming called "FairCare" which is generally the same thing. However they don't start the coverage till 2014. You can however start applying June 1 2011. And it's a first come, first serve basis.

http://www.insurance.pa.gov/

http://www.portal.state.pa.us/portal...ir_care/666211

This may also be helpful. How to choose.

http://www.naic.org/documents/consum...ount_cards.pdf

http://www.portal.state.pa.us/portal...015/health_pdf

This website outlines all the laws and low income insurance Acts in Pa.
http://www.portal.state.pa.us/portal...insurance/9189

Also have you been deemed disabled? If you're receiving SSDI under the age of 65 you can get medicare after a two year waiting period. Which seems it should be coming up soon for you, since this was started awhile ago. I am currently getting SSDI and will eligible in August for medicare. If you are getting SSI though, well you'd be covered under medicaid for a low income, so you're probably not.

I have been my basic own caseworker my whole time in treatment and know the system pretty well. If you have any questions I can try my best to answer.

[reader1587]

Originally Posted by LydiaB

Wow I am glad I switched insurances before this happened. I used to have this same exact insurance. Same area. They did do a poor job at mental health services to begin with. They dropped me a week into my eating disorder inpatient stay because the doctor recommended NG removal. Meaning I could eat without a tube. Forget the behavioral stuff, as long as I'm stabilized medically. The hospital felt so bad that they kept me another 3 weeks free of charge.

this website might be helpful. There is a list of all the insurance companies in Pa and their credentials. I know a few people in at my office who work and receive just over a 1,000 dollars a month that are not eligible for mcaid who receive benefits. It's a shame they recently cancelled adultbasic in Pa. Which was basically the CHIP for adults. They have a new one coming called "FairCare" which is generally the same thing. However they don't start the coverage till 2014. You can however start applying June 1 2011. And it's a first come, first serve basis.

http://www.insurance.pa.gov/

http://www.portal.state.pa.us/portal...ir_care/666211

This may also be helpful. How to choose.

http://www.naic.org/documents/consum...ount_cards.pdf

http://www.portal.state.pa.us/portal...015/health_pdf

This website outlines all the laws and low income insurance Acts in Pa.
http://www.portal.state.pa.us/portal...insurance/9189

Also have you been deemed disabled? If you're receiving SSDI under the age of 65 you can get medicare after a two year waiting period. Which seems it should be coming up soon for you, since this was started awhile ago. I am currently getting SSDI and will eligible in August for medicare. If you are getting SSI though, well you'd be covered under medicaid for a low income, so you're probably not.

I have been my basic own caseworker my whole time in treatment and know the system pretty well. If you have any questions I can try my best to answer.

Hi

Thanks for your responses but I don't qualify for any of the low-income stuff and I'm not disabled, I'm just looking to switch private insurance plans.

[ECHOES]

Paying for your mental health expense on your own may be less expensive than buying an insurance policy. Your mental health providers may offer a cash discount to you when they don't have to answer to the insurance company or file claims and supporting documentation.

Just a thought.