[Tuxedo]

I want to share some good news. There is something called the Mental Health Parity and Addiction Act (MPAEA) of 2008. It states that an insurer cannot place more restrictive financial requirements on mental health care than they place on physical care.

My husband's plan states that a person can have 5 medical office visits a year for $40 a visit with the deductible waived. But it costs $5,000 (the deductible) +30% for a person to have any mental health office visits at all.

I filed a complaint with my Department of Insurance and Aetna immediately caved! If your DOI does not demand compliance, then you file a complaint with the Parity Implementation Coalition in DC and they will file a complaint with the feds.

I hope this helps some one else.

[Fresia]

Thanks for point this out. The coverage for payment has to be the same as a medical provider; however the insurance is allowed to restrict the amount visits or to put your through hoops to get approvals for treatments plans first with you or your providers instead to get around it or by limiting visits. That still can be an issue. There is no way to fight that as it is not covered by the Act.

[lilypup]

For some reason this year, my mental health co-pay has gone down to $20. This has helped us immensely. There is no limit on visits. My regular doc is $20...specialists are $50.
I have no idea why this happened but am not going to ask.

[Tuxedo]

Fresia: The Act prohibits limiting visits to less than the number of visits for medical/physical visits.

[Rose76]

I salute you, Tuxedo. Good for you . . . and for all of us that you knew what to do. Thanks for sharing this. Wow! You stood up to them and you prevailed. A victory for the little guy.

[Pinkflamingo321]

Aetna is terrible for mental health. I'm glad to hear you prevailed! Good work!

[fadedstar]

I guess I'm extremely lucky since I have an employer plan through Aetna (company is large enough to self insure). So far nothing has been rejected for me. My adderall requires a pre approval which my pdoc takes care of. My plan is a straight 80/20 as long as I stay in network and meet the $350 deductible. My therapy copay ends up being $12 and $20 for my pdoc. I have an out of pocket max at $3k after which everything is covered in full. I met that last year between a trip to the ER, an urgent care visit, and a sleep study on top of my regular psych issues. I'm not entirely sure what they're filling out to keep the payments coming but it likely helps that I spent part of last year on STD for this and there's enough of a record on me to prove I need to be in treatment

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[Patsfan]

My Pdoc is $25 same as my PCP. My neurologist is $40

[lizardlady]

Co-pay for my PCP is $30. Co-pay for specialists is $100 (!). Co-pay for my pdoc is $80. Huh?

[Pinkflamingo321]

I go to doctors a lot so I have a platinum policy through the Marketplace, thanks to the affordable care act.

I have a zero deductible with Blue Cross Blue Shield, $10 for my primary care Dr, $20 for a specialist which includes the pdoc. When I've spent $2000 for my out of pocket co-pays, everything is free.

Prior to the Marketplace, all the insurers would sell me was junk policies-- $25,000 deductible for $760/ month premium that covered nothing.

There is complete mental health coverage with the ACA Marketplace, at least here in Florida.

[Rose76]

$760/month is an awful lot to pay for "junk." Glad to hear the the ACA is working out for you.