Can I Keep My Mental Health Providers if I Switch to a Different Insurer's Network?

When it comes to health insurance, changes can happen at any time. Doctors may leave provider networks, employers may switch health insurance providers, and many other issues can cause a change in your plan. If you're wondering if you can keep your current mental health providers if you switch to a different insurer's network of plans, the answer is yes - but there are some things you should know first. The Mental Health Parity and Addiction Equity Act (MHPAEA) requires that health plans provide the same level of coverage for mental health and substance use disorder services as they do for medical and surgical services.

This means that if your current plan includes mental health coverage, the new plan must also include mental health coverage. However, it's important to review the list of providers in the new plan to make sure that your current doctor is included. The MHPAEA parity regulations must be accompanied by a robust application of consumer protections. Regulators should investigate insurance plans that don't meet the full scope of parity and sanction them when appropriate. This includes preventive care without sharing costs, annual behavioral health checkups, appropriate networks, and the absence of differences between behavioral health services and other health services in terms of non-quantitative and quantitative treatment limits. Open enrollment is the time of year when anyone can change their health insurance plan, for any reason.

HHS has jurisdiction over public sector group health plans (called “non-federal government plans”), while the Departments of Labor and the Treasury have jurisdiction over private group health plans. Medicare, Medicaid and the Children's Health Insurance Program (CHIP) are not group health plans or health insurance issuers. People covered by Medicare for America will also have the option to enroll in Medicare Advantage for America plans, based on the private insurance approach allowed in the current Medicare program. Recognizing the likely impact of private health insurance on the workforce, both Medicare for All bills would set aside 1% of all annual national health spending for the first five years to offset the expected economic disruption of private health insurance and bill industry employees. These problems also tend to disproportionately affect people in relatively poor health, with significant healthcare needs, who use their insurance more, and people with modest incomes and limited resources to cover unforeseen expenses. Sanders' Medicare for All bill would allow private contracting between healthcare providers who don't participate in the universal Medicare program and patients, and would allow private insurance to cover these costs, a practice that is generally prohibited under the House bill. In fact, an online survey by the National Alliance on Mental Illness (NAMI) among people with mental illnesses who had private insurance, along with their families, revealed that respondents were more than twice as likely to have their private insurance company deny them mental health care for reasons of medical need, compared to other types of medical care.

With demand for behavioral health providers that far exceeds supply, coupled with low reimbursement rates, many behavioral health providers are able to obtain a sufficient customer base without having to accept insurance. Employment-related group health plans can be “insured” (buying insurance from a group market issuer) or “self-financed”. Group health plans that pay for coverage directly, without taking out health insurance from an issuer, are called self-funded group health plans. Evidence shows that the general public is satisfied with their health insurance coverage, which could explain why the question of how private insurance is treated in public plan and Medicare option proposals has become a controversial topic in the Democratic primary and influences public opinion. As a state government agency that intensifies its efforts to oversee and enforce MHPAEA, the Pennsylvania Department of Insurance should serve as a model for other state governments seeking to hold insurers accountable. Access to quality, affordable, and affirmative mental health services is necessary to address the disproportionate impact of unmet behavioral health needs on vulnerable populations.

Tommy Gair
Tommy Gair

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