Unequal Treatment: Mental health parity in North Carolina

This series of stories explores mental health parity— the concept and practice of treating mental and physical health equally—in North Carolina.

North Carolina gets a ‘F’ on how equally it treats mental and physical health issues

What is parity, why do we rank behind other states, and what do these rankings mean?

A colored map of the U.S., most states are red, a few are orange and yellow, Illinois is green — Most states failed this grading of statutes protecting mental health parity, with Illinois as the sole “A” in the country. Map source: Parity Track

How to file a parity-related complaint

The Kennedy Forum offers a step-by-step guide for the appeals process.

Patients and providers can submit complaints to the NC Department of Insurance here.

After complaining to NC DOI, people can register their complaints with Parity Track, a database formed with the aim of changing national policy.

NC DOI is a NC Health News underwriter.

shows a silhouette of a person sitting hunched on the floor, that's devolving into question marks and triangles — Image courtesy: Gordon Johnson, Pixabay

Mental health parity isn’t panning out for some patients and parents

A federal law is supposed to guarantee that mental health patients get treated the same as other patients, but that’s not been the case for these three patients who tell their stories of struggling with insurance companies.

Response for Maggie N BCBSNC 23Feb18 (Text)

shows two silhouettes facing one another — Image courtesy: Gordon Johnson, Pixabay

Mental health providers struggle with disparities in the system

Patients aren’t the only ones affected by how insurers often treat medical and behavioral health issues differently—providers are also struggling to get by on reimbursement that’s often lower than that for physical health treatment.

A bar graph showing high pay rates for primary and specialist office visits and low rates for behavioral office visits — Nationally, behavioral office visits get paid far less than the Medicare fee schedule. Graphic credit: Milliman

shows a line drawing that outlines a head, but the line is also an electical cord with a light bulb at the end — Image courtesy: Gordon Johnson, Pixabay

Determining disparity in mental health treatment can be difficult

Even when patients suspect insurers are not covering their mental illness on par with how they’d cover a physical problem, proving it can be a challenge.

Though historically the Department of Insurance accepted around half of complaints for external review, in 2018 that number jumped to 71.52 percent. Graph credit: Yen Duong

shows the silhouette of a brain and the silhouette of hands cradling the brain — Image courtesy: Gordon Johnson, Pixabay

Most states don’t do well with mental health parity, but others are setting an example for enforcement.

Some states have involved mental health advocates in creating policies around mental health parity, and gotten more effective enforcement. States such as New York and Illinois are leading the way and showing the rest of the U.S. how to write and enforce policies that protect consumers of mental health treatment.

NAMI-NC and Mental Health America, which has five local affiliate programs in NC, both offer resources to support people and families dealing with mental illness.

This series was inspired by the ten-year anniversary of the Mental Health Parity and Addiction Equity Act and our Q&A with former congressman Patrick Kennedy, who founded the Kennedy Forum.

A woman interviews a man in a suit sitting at a black wood table with coffee and water in front of a window with greenery. — Reporter Yen Duong interviews former congressman Patrick Kennedy on September 12, 2018 at an Atrium Health fundraiser at Carmel Country Club in Charlotte. Photo courtesy: Atrium Health

Patrick Kennedy- Fighting for Mental Health Parity

Former congressman Patrick Kennedy has a lot to say about the opioid crisis, medical marijuana and where the U.S. should go in addressing addiction.