For persons faced with mental illness, insurance can be a blessing.  But when one's insurance refuses to cover mental health services, it can be a bane.  As part of VPA's mission to promote human welfare, the aim of this page is to provide helpful resources to the Vermont consumer who faces - not only mental illness - but the challenge of working with an insurance system that can be daunting at times.  On this page, you will find (a) a summary of VPA's role in advocating for access to mental health care in Vermont, (b) what to do if you run into insurance problems, and (c) a list of online resources for the consumer.  In the online resources section, We have also added a couple of links to help clarify consumer details and impacts of the 2010 Health Care Reform legislation.

VPA's Role in Advocating for Access to Mental Health Care in Vermont

As far back as fifteen years ago, the mental health coverage scene was mixed.  Indemnity plans that paid the psychologist's going rates were present and some had no limits on the number of psychotherapy sessions per year.  However, other insurers did not even have to offer a mental health benefit.

On January 1, 1998, mental health parity legislation took effect in Vermont.  As reported by Vermont's Banking, Insurance, Securities, and Healthcare Administration (BISCHCA), Mental health parity "requires your health insurer to cover mental health and substance abuse services at no greater cost to you than other health services."  However, this came with its own difficulties in turn.  The scene switched from one where indemnity plans were the norm to one where "managed care," or specialized companies with the sole purpose of managing the mental health benefits, became the norm.  Provider panel limitations created access and reimbursement problems.  Employers sometimes switched insurances in an effort to help keep employer costs down, but this sometimes left client and provider alike in a quandary when the new insurance did not have the provider on its panel – and the insurance refused to cover further services.  Similar nightmares occurred when the client switched to a new job where the employer offered a different insurance.  Some managed care companies made life more difficult for client and provider alike by doling out pre-approval for sessions in only small drips and drabs at a time.  Can you imagine someone with diabetes where the physician would have to write in for pre-approvals to continue to treat the diabetes? 

Through the advocacy of VPA psychologists and other concerned citizens, there have been continued improvements in the mental health access scene.  Panels are now open to any qualified mental health provider (with some exceptions).  Requirement for treatment pre-approvals is relatively less stringent than in the past (again with some exceptions).

On the national level, some legislated improvements are only just beginning.  Medicare's whopping 50% copay for mental health benefits will begin tapering toward the more modest 20% copay as is already the case with Medicare's physical health coverage.  Many (but not all) self-insured companies that were exempt from state parity laws (under ERISA) will soon be adopting mental health parity under recent federal legislation.  And the Health Care Reform legislation passed in 2010 promises increased access to mental health resources for many Americans as it unfolds.  (See the "Online Resources" section below for a link to some of the general benefits of the 2010 federal legislation.)

Addressing Insurance Problems

Please note that the VPA does not provide consumer insurance counseling.  The agencies cited in the online resources below are the ones to turn to for that – especially BISHCA.  Also, let your treating psychologist know.  He or she will likely have a vested interest in helping you in the process of straightening out insurance problems.  But do let your psychologist know at the earliest hint of trouble.  A problem caught sooner rather than later may be more fixable.  A psychologist may be able to submit a complaint to BISHCA on a consumer's behalf, but note that our experience is that the complaints tend to be more powerful when submitted by the consumer him or herself. 

Online Resources 

* THE SKINNY ON HEALTH CARE REFORM:  The AARP has an online document entitled "A User's Guide to the New Health Care Law."  Also, the Cancer Action Network has a handy list of consumer benefits and the corresponding rollout timeline.  The document is entitled "Health Care Reform: Timelines for Implementation."

* ONLINE CONSUMER GUIDES TO INSURANCE:  Health Insurance Online provides some of the most intensive online insurance tools for consumers that we've come across to date.  This site includes an HTML version of a book by Richard Epstein on understanding and working with insurance systems.  This is a must read for the consumer who feels he or she is getting the run-around from his or her insurance.  This is clearly not light summer reading however.  There are other online books and texts available as well.  As we have not had opporunity to preview the extensive resources listed on this site, please note the disclaimer at the bottom of this page.  

* BRIEF TIPS ON KEEPING HEALTH CARE COSTS TO A MINIMUM :  Reader's Digest provides a brief article with steps on using your insurance wisely. 

* PROBLEMS WITH COMMERCIAL INSURANCE IN VERMONT:  The Banking, Insurance, Securities, and Health Care Administration (BISHCA) is Vermont's governmental agency in charge of regulating in-state commercial insurance.  This is the organization with whom one might file a complaint or request an appeal in the State of Vermont.  They also offer information on how to obtain health insurance if you are not already receiving any.  Bravo to BISHCA for the new, clearer layout of their website.  Their commitment to serving the Vermont health care consumer is evident. 

* PROBLEMS WITH VERMONT MEDICAID OR VHAP:  The Office of Vermont Health Access (OVHA) is the organization that supervises such state programs as Medicaid and VHAP.  Call the customer service number on the back of your insurance card as a first step if you are having coverage problems.  The OVHA consumer website serves as an additional resource.  As of 6/25/10, the site leaves a bit to be desired for usability with at least one dead link on the site. 

* BENEFITS OF DIRECT PAY FOR PSYCHOLOGICAL SERVICES:  The American Psychological Association's Division 42 provides a nicely written explanation of the potential benefits of paying for psychological services out-of-pocket instead of using your insurance benefits.     

Disclaimer:  This page contains off-site links.  The purpose of the links is to provide additional information and resources that may be of benefit to the visitor.  However, VPA is not responsible for the content of the off-site links and does not attest to the accuracy of the information contained therein.  The content of off-site links does not necessarily reflect the opinions of the VPA.  VPA privacy protections do not extend to external links that are not managed by us.

Last Revised: 6/25/10