There is widespread concern about the adequacy of mental health benefits in private insurance. A long-standing issue has been insurers' tendency to offer plans with dollar or utilization limits beyond which mental health care is not covered. Some have argued that such limits should have become less necessary with the spread of managed care plans, which have other tools available to manage enrollees' utilization. We examine current levels of mental health benefits in managed care plans using data from a nationally representative survey of managed care organizations about their behavioral health care provision. Researchers at Brandeis University conducted a telephone survey in 1999 of 400 organizations in 60 market areas nationwide, achieving a 94% response rate. The sampling strategy includes stratification by two types of product offered (PPO-only, or other) and allows for nationally representative estimates. Each organization reported on up to 3 products, which for most included the majority of their commercial products. This paper reports findings on mental health benefits from the administrative module. Respondents were asked whether they covered specific services, and what deductibles, copayments and coverage limits enrollees faced. Our survey also tracked differences in these approaches among an organization's different products (e.g. HMO, PPO). The results indicate that many plans still include annual limits on mental health care, but these limits most often apply to days or visits rather than dollars. Plans are using a type of limit which is not affected by the recent Federal parity law.
Learning Objectives: Participants will learn what mental health benefits are typical in managed care organizations
Keywords: Insurance, Managed Care
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.