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Federal and state laws require insurance companies to cover mental health just as they would medical care, but actually getting insurance for mental health treatment can be tricky. In California, the Legislature is trying to make that promise real. Yesterday, it passed one of the country's strictest mental health parity laws, as NPR's Yuki Noguchi reports.
YUKI NOGUCHI, BYLINE: When Monica Vera-Schubert's (ph) son Bobby injured his knee a decade ago, she monitored his painkiller prescription until it ran out.
MONICA VERA-SCHUBERT: That's where, all of a sudden, his behavior started changing to the point that he was no longer a friendly, happy-go-lucky kid.
NOGUCHI: He raided his grandparents' medicine cabinet and sold off his mother's jewelry to feed his growing addiction. Where Vera-Schubert lives in Burbank, Calif., state and federal law already require insurance companies to cover mental health as they do medical care. But she says she encountered multiple hurdles. Once, her insurance preauthorized her son for inpatient rehab. But when he showed up...
VERA-SCHUBERT: They couldn't get the insurance to coordinate with them, so my son walked. He walked home to his grandparents' house, and he goes, I'm never going back there again.
NOGUCHI: She ran into other roadblocks as well - long waiting periods, requirements he test positive for drugs. Paying out of pocket would've cost nearly $50,000 for a single month.
VERA-SCHUBERT: It felt terrible and overwhelming (crying) - so overwhelming that how many times I'd have to fight for my son and...
NOGUCHI: Bobby eventually received treatment and entered recovery, but only after getting off her private insurance and getting on California's public Medicaid program. Advocates for California's new proposal say it would strengthen existing law and close loopholes insurers use to deny many mental health claims. It would expand coverage for more than 13 million Californians with private insurance. It would increase the list of illnesses covered, most notably addiction. Meanwhile, America's Health Insurance Plans, the industry's association, has argued it is already in compliance, and therefore a new law is unnecessary and would add to administrative costs.
Patrick Kennedy is a mental health advocate and former U.S. congressman who co-authored the landmark 2008 federal law requiring equal insurance treatment of mental health. Insurers, he says, haven't complied.
PATRICK KENNEDY: Fact is that they're not covering it, and it's discriminatory to people who are suffering from mental illness and addiction, especially in a time when our country is crying out.
NOGUCHI: Kennedy says the California bill, if signed into law, could become a model for other states and prompt insurance companies to change policies nationally. Mayram Bendad (ph) agrees. He's both a lawyer and a psychotherapist in Los Angeles.
MAYRAM BENDAD: The biggest tool that insurers have to deny coverage is by saying that treatment is not medically necessary.
NOGUCHI: Bendad won a national case against United Behavioral Health last year, arguing the insurance giant improperly denied coverage. He says a new California proposal would address one gaping problem - it would no longer allow insurers to write their own rules about what to cover. Many of the patients Bendad represented were denied inpatient addiction treatment.
BENDAD: They couldn't afford the care. They didn't get the care. They overdosed and died. And there is absolutely no ability to get punitive damages.
NOGUCHI: Families couldn't sue for damages under federal law, so Bendad says insurers have little incentive to change. The proposal now heads to California Gov. Gavin Newsom's desk. His office declined comment about whether he intends to sign it.
Yuki Noguchi, NPR News.
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