Fed Employees: Health Insurance Advice for Mental Health Coverage, e.g., PPD?

[Anonymous]

But would the mental health parity law apply if the insurance company offers no coverage for out of network providers, irrespective of what kind of physican they are (general, oncology, psychiatry, etc.). It seems that in OP's case her BCBS basic plan doesn't cover anything out of network. And she is unable to get an appointment with anyone in network. That's terrible. I'm really sorry, OP. Definitely switch to another plan that has out of network coverage, so at least you can start getting some reimbursement in 2014.

[Anonymous]

Anonymous wrote:But would the mental health parity law apply if the insurance company offers no coverage for out of network providers, irrespective of what kind of physican they are (general, oncology, psychiatry, etc.). It seems that in OP's case her BCBS basic plan doesn't cover anything out of network. And she is unable to get an appointment with anyone in network. That's terrible. I'm really sorry, OP. Definitely switch to another plan that has out of network coverage, so at least you can start getting some reimbursement in 2014.

There are two issues here. One is that if there is only in-network coverage and they provide mental health treatment then she has to be able to access that coverage. That means that if they only have one provider and that provider isn't taking new patients or practice a two hour drive away they are essentially not providing her that coverage. they are making her jump through hoops to get the treatment that it supposedly provided by her plan. this applies whether it is for physical or mental health coverage. if the insurer is putting barriers in her way to getting treatment such as having an extremely limited provider pool then they need to expand that pool. to do this they can either recruit new providers to be in network, or she can argue the case that they pay for her to see an out of network provider -- even though she doesn't normally have out of network coverage. the insurance company is obligated to offer an in-network provider that is taking patients and is located within a reasonable radius of where she lives. They are not obligated to cover a provider or her choice, but they should provide a reasonable option. If there is none there is a good case for making an out of network exception.

The second issue is parity - and this may or may not apply. However, if the insurer's network for mental health providers is significantly more restrictive than for other similar providers in the physical health area then this could be a parity issue where the insurer is failing to comply with the parity law by putting barriers in place that prevent the consumer from accessing services.

[Anonymous]

With respect to coverage of out of network psych treatment, if you do switch to a plan with some out of network coverage, I have found GEHA standard to be much better in every way than BCBS. Cheaper, easier to file claims, and reimburse much more for therapy (whatever their reasonable and customary charges are, it's at least 200 a session and I get reimbursed 60% for out of network).

[Anonymous]

Have you been trying hospital based outpatient psychiatry? All the area hospitals contract with BCBS. Can be difficult to get started, try to see them before you deliver so that you will have an easier time getting an appt after baby is born. If your need is urgent, OBs can either write scripts for meds OR contact the psychiatry office on your behalf to lobby for you to get seen more quickly.

[Anonymous]

I see Audrey Rushin in Burke VA for ppd and she takes BCBS basic. She's going to drop all insurance in Feb next year but maybe she can fit you in for the next couple of months.