Mental Illness

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DULUTH — Pull out your health insurance card.

Is there a number for a mental health crisis line on the back?

Perhaps there is, but you might not know that by looking.

“One of the things (insurers) said was that their … health plan members had access to a crisis number for mental health,” said Sue Abderholden, director of the Minnesota chapter of the National Alliance on Mental Illness. “But … we all pulled out our health insurance cards. And it didn't actually say ‘mental health crisis’ on the back of the card. It actually just talked more about a nurse line. And so if you were having a mental health crisis, it might not occur to you” to call that number.

Abderholden was commenting on one of the disconnects that became apparent in a study this year of the mental health coverage provided by three major commercial insurers in Minnesota.

The nutshell version: Those insurers — Medica, Minnesota Blue Cross and Blue Shield, and HealthPartners — provide better coverage for mental health than their counterparts in most other states. But they fall significantly short of providing mental health coverage that’s on par with medical coverage.

The study, titled “eValue8 Mental Health Deep Dive survey in Minnesota,” was conducted by the Minnesota Health Action Group, which represents a large number of major employers, including Best Buy; the cities of Minneapolis and St. Paul; Hennepin, Olmsted and St. Louis counties; and the University of Minnesota, among others.

A report by the same organization last year focused on depression care in the state. It found the overall picture in Minnesota abysmal. It also highlighted a few bright spots, including Essentia Health’s clinics and Best Buy’s mental health policies for its employees.

This year’s study relied on the cooperation of the insurers. But if you’re insured by one of them and want to see specifically how it performed, you’re out of luck. In the report, they’re identified as Plans A, B and C. We know who the insurers are, but we don’t know which insurer goes with which letter.

Deb Krause, vice president of the group, acknowledged in an email that most employers, too, would rather have the plans identified by name in the report. But since this was a first-time thing, she said, it was decided to give some level of anonymity to the insurers.

“This allowed them the benefit of learning and the opportunity to implement quality improvement initiatives before being publicly identified,” Krause wrote. “Moving forward, we expect to have greater transparency when the exercise is repeated in the next 2-3 years.”

That said, none of the insurers emerged as either hero or goat, Krause said in an earlier telephone interview. Each had areas of strength when it comes to mental health coverage, and each had weaknesses. The strengths and weaknesses balanced out from one insurer to the other. They came out more or less even.

In addition to using letters, the report uses colors, Krause explained. In each area, the plan was graded “green” if expectations were met, “yellow” if improvement was needed and “red” for unacceptable.

“There was, unfortunately, too much yellow and too much red,” Krause said.

A glaring weakness for all three plans concerned the amount of time health plan members have to wait for mental health care. One of the plans reported a 24-hour wait time, and the other two reported 48 hours, Krause related.

“Well, that sounds pretty good, right?” she said. “But they aren’t able to measure that, and they don’t report it to the employers. So having a standard is wonderful, but not knowing what percent of the time you meet the standard just really is a problem. … The employers are hearing stories of people (who) wait weeks, they wait months to get access, and so that’s the disconnect.”

Although there’s a shortage of mental health providers in much of the state, Krause said the insurers need to broaden their networks so more providers are available for their members. They also need to do a better job of updating their directories “so that the patient doesn’t have to call number one, number two, number three, all the way down to 20 or 30 on the list to find somebody.”

One might think access would be better in the Twin Cities, but Abderholden said that’s not the case.

“We continue, even in the metro area, to get complaints from people and families that they cannot get in,” Abderholden said. “And we also hear from providers who say they can’t get a contract with the health plan … especially in the metro area.”

In regards to what she calls “network adequacy,” Abderholden said public insurance does a better job than commercial insurance.

“Until more recently, private insurance was not covering residential treatment for mental illness,” she said. “And that’s a huge issue. Medicaid covered it; they didn’t.”

Abderholden has found that employers have been unaware of how limited mental health coverage is, she said. She’s excited by the report, she added, because employers are in a position to insist on better coverage.

“It’s the people who are purchasing plans for their employees saying, ‘I want more covered,’” Abderholden said. “‘I want to make it easier for my employees to access mental health care because I know they’re going to be better employees.’ … This is just a different way to push health insurance to really treat mental health like it does every other health care issue.”

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