.
The following page of my specific questions is first so that
people I'm simply e-mailing the URL of it to can easily find it.
My current questions about mental
health parity and coverage in Texas.
This site is still developing as I continue to learn more and to learn about more resources, so people should continue to check this site for further information.
This site came out of the problems I have had trying to get proper mental health coverage to treat my depression/ "suspected" bipolar disorder. I recently moved to Austin, Texas, from Buffalo, NY. In Buffalo, I worked for a good company with good health insurance options and had Community Blue Advantage, which was Community Blue HMO with an additional point of service (traditional indemnity) contract. I describe this experience in my page about my Community Blue contract. Basically, I didn't have coverage, or not as nearly as I was ever able to learn from them. I moved to Austin seeking better job prospects and better health insurance. Texas has a mental health parity law on its books - and the law itself is a good one. But when I carefully checked on what it covers and how it applies, and what to look out for in terms of companies not providing insurance, I could get only, from all kinds of other mental health consumers and from people in mental health advocacy alike, vague answers that the law is very weak and doesn't do anything.
This is basic consumer information that one should be able to just look somewhere or ask someone and find out. But I've found it very difficult to find. For one thing, local mental health advocacy groups haven't kept up on it since they worked very hard to pass the law two years ago, and I've found that few of those currently in Austin have done anything as basic as read the law - even if they helped pass it! A key reason for poor compliance with the law is a federal law called ERISA - and about half of the mental health advocates I spoke with don't know what ERISA is or does, and the rest didn't know how the specifics of how it impacts on the state parity law.
At the same time, local NAMI, which has an active interest but no information, and another local advocacy organization, told me that they were approached by about 5 other people with the exact same questions within a week of when I first contacted them - and they didn't have the answers for those people, either.
A variety of organizational dynamics explain this. Advocacy Inc and Texas Mental Health Consumers focus exclusively on serving those of the mentally ill who are severely and chronically disabled or institutionalized, but aspects of their names, their histories and their functions suggest otherwise, and they don't clearly explain themselves to people who go to them. One particularly confusing aspect of Advocacy Inc is that a number of its people either as an outside interest or in a previous existence, actually did participate in the effort to get the state parity law passed - and not one of them has stayed up on the issue. Also, Advocacy's role of helping consumers on Medicaid and educating people in Medicaid Managed Care creates the impression that they do health insurance - which they don't. TEXAMI fell apart when its small core of active and capable people variously moved on to national NAMI's offices in Washington DC and left town. One of those people is moving back to Austin in June, which may help. The Mental Health Association contains a single very knowledgeable prince(ss) in a pond full of frogs. Mental Health Association people generally are usually frogs. They give anyone with questions an attitude and not much help getting through her - though I understand it does help if one has a phone where she can call back. The Austin NAMI chapter try as hard as they can to be helpful and sometimes have people actively working on particular issues, but they have little knowledge of this or any other insurance issue, and they're waiting on what I find out.
People who do have the information and/or are concerned enough to go get it are several people with national NAMI, the former active TEXAMI members who left town, several people high up at the Texas Department of Insurance, and legislative and public policy people at the Texas AMA and the Texas Society of Psychiatric Physicians, and one single person at the local Mental Health Association, who is extremely good only most of the other people at that office aren't as good. It took a long time to learn who these people were and far longer to reach them - as they are all extremely busy and spend most of their lives out of town doing their legislative and policy work. The fact that I don't have proper resources for long distance phone calls and receiving phone messages slowed me down alot. I also ran into a fair amount of people more concerned in one way or another with their organization's image than with being helpful or at all straightforward with me, which exists everywhere, but it got in the way of my efforts to get information and caused me to waste alot of time, and it greatly aggravated me. I got the idea they thought I would just kind of disappear or dissolve or something before I got the answers to my questions. One of them outright thought I'd disappear if he told me to and NAMI couldn't help me! I'm quite pleased to disappoint these people.
I do still have a couple of people in charge of complaints at TDI I haven't been able to talk to yet, as well as someone at national NAMI and other aides in Congress and in Tipper Gore's office who have an active interest in what is going on with the states who have passed these laws - and a Congressional hearing scheduled to be held in approximately April on a federal parity bill that is before Congress will look at state experiences and if I missed something, they may find it. It would sure be nice if I change this site next week to include the responsible and knowledgeable knowledge source I haven't found yet; but whether that happens or not, plainly this information isn't where consumers can find it!
From talking to mental health consumers all over Austin, and from talking to mental health advocates in Austin, I get the distinct idea that most mental health consumers in Texas really are not at all aware of the state law. This with the fact that exactly one hard to reach and out of the way person in mental advocacy in this city knows much about the parity law at all, causes people who ask questions to get the sort of extremely vague and at times very misleading information that I got. Most people appear to be aware only of the federal law, and principally know that the federal law isn't worth a darn and doesn't do a darn thing. I'm also finding that peoples' perception that the state parity law is a poor law comes partly from the fact that most of the people I talk to don't personally have very good mental health coverage, which often is clearly written around the federal mental health parity law, and they don't know the law well enough to clearly understand why their coverage is so poor.
Moreover, most people and many mental health advocates in this city appear to have the federal law and the state law confused with each other. They told me all about the state law - only the things they told me describe the federal law. Two of Jay Leno's top ten ways to know what law one is hearing about are: "most employers just switched caps on dollar amounts for caps on days", and "I am allowed just twenty outpatient visits a year because most employers just switched caps on dollar amounts for caps on days." Those two statements are typical ways companies worked their policies around the federal law, and are quite vividly not possible in any insurance or HMO contract that complies with the Texas state law. The Texas state law requires a minimum of 60 outpatient visits per calender year for everyone it covers atleast in the private sector, and since the Texas state law doesn't contain as its sole actual provision a prohibition against setting lower lifetime and annual caps on dollar amounts for mental illness than for other health conditions, but rather requires full parity on all terms, there is not a clear advantage to a company to switch from dollar caps to caps on numbers of days covered. This confusion leads people to wrongly believe that the state parity law is a poor law that can't protect them, and also results in people like me getting very confused and vague statements from practically everyone, especially people in mental health consumer support groups and people in mental health advocacy, who it is reasonable to think would know and would tell you the straight story, that the state mental health parity law is a very poor and weak law and doesn't do anything.
Obviously, the fact that both people and the organizations and agencies they naturally turn to for information and for help know so little about the state parity law is an even more serious problem than the closely related problem that this information is nowhere where the average consumer can find it. Obviously, there has been total educational failure concerning this law. This could well be the explanation of why NAMI and state insurance people are (so far, I haven't yet talked to some of the probably most knowledgeable people in TDI) telling me they are getting plenty of complaints about insurance, but none about compliance with the mental health parity law. Clearly most of the people who have been telling me they have poor mental health coverage on account of the parity laws, would not know it if their own insurance policies were required to comply with the state parity law and did not do so. So how would they be filing complaints about it? Further, almost everyone I've spoken with sound and are often markedly acting as if they take insurance companies denying coverage and avoiding payments as for granted as they do droughts in the weather (in central Texas). This kind of passivity is in the way of further legal reform, since the embattled bills in Congress that would fix much of parity's actual problems need consumers lobbying for them in order to pass, and it can be fixed by people knowing of the strong laws and mechanisms that exist to protect them.
The level of difficulty I and others are having getting complete and specific information about this law necessarily means that something has gone seriously wrong in educating the public and with making information available where the public can find it. It is possible, though, that much of the low level of knowledge and awareness about this law and the people having the state and federal laws confused, is due to the fact that the Texas state and the federal parity laws happened to be passed and to take effect at the same time, and there was ALOT of coverage of the federal law in the media and in mental health - related organizations and their literature. It may have simply overwhelmed any effort that was done when the Texas law passed to educate consumers about it. I also kind of wonder if perhaps the Texas Department of Insurance kind of thinks of the entire subject as outright a disability issue, not one that hundreds of thousands of ordinary and productive Texans exactly like me need to know about because we are dealing with it.
In the meantime, it has taken me a full month of trying to find out this information to get it. Not only was this research itself a full time job, but I needed the information before I can start looking for a job. I need a job that provides proper mental health coverage, and I need to know how to find one before I start looking. In Austin, job searching itself is a full-time job and cannot be done if you already have a full time day job. Most jobs have waiting periods to be on their health plan. Getting the wrong job would only delay my getting the care I need that much longer. So for an extra month, after moving to this city with little resources other than that my sister lives here, I've been scrounging on a part time evening job, selling plasma, a neighborhood food bank, and hitting on the Bank of My Sister - and not even beginning to look for a job.
I feel rather strongly that noone should ever have to go through this again, and it can be avoided rather easily simply by putting the information I am finding in a location where in the future everyone will be able to find it very easily - which is on a web site. I am not unexpectedly learning from some of the organizations I went to for the information that since I went there other people have come along with the same questions, and they didn't have the answers for them, either. So there is a clear need for this information in a single place where people can easily find it.
Austin, Texas and Texas state level mental health advocacy organizations This page contains information about and how to contact all Austin area mental health advocacy organizations and other advocacy and policy organizations that are relevant to parity, as well as the state Department of Insurance - together with some basic information about them and how useful I've found them.
My page that explains overall how the state and federal mental health parity laws are and aren't working, in detail. This page is my working draft of a brochure I'm in the process of constructing - and it is likely to take me days to finish constructing it and to get it right.
text of the Texas mental health parity laws , includes a couple of good references on the ERISA problem, but most of them are in my national level resources page.
Not everyone who looks at this page is going to be from Texas. While it isn't even the best short summary of state parity laws I've seen, here is a link to NAMI's state parity laws page. It will atleast tell you if your state has such a law. NAMI's page perhaps wisely took it out, but many similar pages contain misinterpretations of what employers and health plans the ERISA preemption applies to. (NAMI's state laws person has by the hard and lengthy work it required only just updated herself on the actual meaning of that preemption.) It isn't always right up to date; Texas passed an important amendment in 1999 that added an important protection to the law, and it isn't on NAMI's chart. That bill is most often characterized as just a cleanup bill - but it did sneak in a prohibition against different copays, deductibles (I think) and percentages the insured has to pay for mental health care than for other forms of illness.
legislative history of Texas mental health parity law and Texas on-line legislative resources Also some sources of info on the problem with ERISA. This page contains information one needs to find the law itself and many kinds of information that have to do with it, such as who testified at hearings on the law and what was the testimony.
Congressional mental health parity bills and other Federal resources Links to where to find the text and status of both the two parity bills before the Senate and the House, which are similar but not identical, and the House and Senate versions of the current patient rights' bill, which is currently in conference committee since the different bills each passed their respective houses. There are key differences between the latter bills, for instance, one contains the right to sue HMO's, when wrongful decisions result in serous harm or death, and the other doesn't. President Clinton called for hearings on how the mental health parity law of 1996 is working, and there is a growing momentum to tighten up the 1996 law, on top of bills to do so sitting in Committee in both the House and the Senate since last spring. The aide of one of the two Senators who is working on the parity bill wrote me that a hearing is likely to be held on the Senate bill sometime in April, possibly in May.
Congressional hearings on mental health parity (that I know of). Includes hearings since 1987 on quality of health care in managed care, health care under ERISA, and HMO patients' rights. I also listed several court cases, most of them current, on ERISA and its preemptions and on mental health parity and managed care patients' rights ni particular.
A discussion of the provisions and shortcomings of the FEderal
Mental Health Parity Law of 1996 (effective beginning of 1998
for policies negotiated after that date). Also, a copy of the text of the law. I also have on this page information on New York State's efforts to pass a mental health parity law that is up to date as of summer, 1999, and won't be updated.
National level resources on
mental health advocacy and/or parity, on ERISA, on behavioral managed care, and on managed care reform, gleaned from hearings, articles, and the web. I have quite a collection of the central resources on these topics on the web, with input from other people as well as the results of my own searching.
Some extremely good resources that explain ERISA and its preemptions are on this page.
My list of the companies I've been
able to learn about, most have
publicly said they offer mental health parity or been praised
for doing so. Most of these are large inter-state employers
who self-insure, and most offer behavioral managed care sometimes
combined with an employee assistance program. Some of them have
drawn praise, awards from NAMI, etc., but I do not at this time
know why. I got these from hearings and articles and the NAMI site,
and from word of mouth (in the case of Dell).
A copy of the parts of my former Community Blue HMO contract
from Buffalo, NY This is a very good specimen of why the
Federal Mental Health Parity Act needs to be amended.
Austin mental health resources
(support groups and places to go for care) There is also a need for all of this information in one place where people can readily find it!
my genealogical site I traced the manic depression and
other mental illness back in both my parents' lines, in several
cases for four hundred and more years - and these lines are
full of very remarkable people and stories. That's, every sort of remarkable. From extraordinarily productive people and community leaders to some of the main characters in the Salem witch trials.
Go to my main bipolar page for
links to general information about
bipolar disorder, other forms of mental illness, and tracing
mental illness in your family.