[learning1]

Wow, I just called my insurance company and was told that as of July 1, due to a U.S federal law called Wellstone (he was a senator that died in a plane crash), there's no more limit on the number of therapy sessions I can go to in a year, as long as the sessions are medically necessary. Has anyone else heard about that? I wonder why my various therapists (I've been shopping around) haven't known about it. I wonder why when I called my insurance back in October to find out how many visits I had left they didn't tell me about this. Maybe it's just taking a while for everyone to learn.

I asked the insurance rep if medically necessary meant as long as the therapist said it was necessary (which, I assume, therapists would be happy to do). His response was, "um, yup, as long as it's medically necessary". That seemed a little vague, but I think it meant yes.

[learning1]

My understanding was it meant July 1, 2010, so it already started.

[skeksi]

A huge aspect of the law is also that it eliminates separate deductibles for mental health coverage. For example, I used to have to pay my medical deductible and then I had a mental health deductible as well; now I just have one to pay for both.

The law ensures parity, so the wording specifies that mental health visits can't be limited unless physical health visits are subject to the same regulation. I do still have a maximum number of visits per year, but it is such to allow for weekly therapy--twice weekly visits would not be covered, though, so my coverage is not unlimited. I have a limited number of visits to certain other specialists, so this appears to demonstrate parity--they aren't restricting my mental health treatment any more that they do other health treatment.

I would love to hear from people who work in mental health who are more familiar with the law.

[mixedup_emotions]

A couple years ago, I ended up paying out-of-pocket for my therapy visits for more than half the year because my visits were capped. Now, I have unlimited visits. There are loopholes though. I heard that it only applies to companies that have 50 or more employees. If my company cuts back any more, it will be under 50 and I'm sure this will be affected for cost saving purposes. Yikes.

[BlackCanary]

It's part of The Mental Health Parity and Addiction Equity Act of 2008
Here is a fact sheet from the Dept of Labor
http://www.dol.gov/ebsa/newsroom/fsmhpaea.html

At my company, it meant that co-pays became the same for medical and mental health visits, went from $25 per visit to $15 per visit in 2010.

Yes, it applies to firms with more than 50 employees, MUE. But, they cannot change how you are covered in the middle of the plan year.

[learning1]

Would be nice if my insurance company reduced my copay to what I pay at other doctors. But maybe there are specialists where they charge a $25 copay that they consider equal to therapy.

It seems like different insurance companies are interpreting the law differently.

Thanks for the info, everyone.

[The Poet]

In many instances, it is also removing the need for "pre-authorization" of services. Just go.

Most providers are still weary of the law, because they don't want to get screwed out of their money...

[emilyjeanne]

Originally Posted by The Poet

In many instances, it is also removing the need for "pre-authorization" of services. Just go.

Most providers are still weary of the law, because they don't want to get screwed out of their money...

There is a list of "medically necessary" diagnosis. Like for instance Major Depression is considered medically necessary. It would be worth your while to do a search to see what diagnosis' are considered.

Also, most insurance companies do not want you to know that the law exists. So they will not offer this information to you unless you specifically ask.

I have had an excellent plan and have been covered without a limit of visits. But I hear alot of people are having a difficult time.