Depressed employees miss more work, are less productive and make poorer decisions than their healthier colleagues, or even those suffering from physical ailments such as back pain or hypertension.
But mental disorders, ranging from depression to bipolar disorder to alcoholism, have long been stigmatized and underestimated. For many health insurance plans, the result is fuller coverage for physical ailments.
Not so for federal employees who participate in the Federal Employees Health Benefits Program, which is run by the Office of Personnel Management and offers dozens of insurance options for its 8.5 million participants.
Since 2001, OPM has required FEHBP providers to offer equal benefits coverage for mental and physical ailments. That means participants pay the same deductibles, co-insurance and co-payments for both categories of illness. They also can make the same number of outpatient or inpatient visits.
Five years later, researchers have concluded that parity not only resulted in improved insurance coverage for mental illness, but did so without a significant increase in total costs for the providers.
A March study published in the New England Journal of Medicine found that in five of seven FEHBP plans examined, the amount participants spent on mental health care decreased about $13.82 to $87.06 between 1999 and 2002. But they found no significant increase in total spending by providers on mental health.
Earlier studies found small increases in costs when mental health parity began, but they were comparing plans before and after parity took effect. This study compared plans with and without parity over the same time period, eliminating external factors for a greater use of mental health treatment.
"What we found is it's a really good thing we had a comparison plan," said Howard Goldman, a University of Maryland psychiatry professor who led the study. "It didn't go up any faster than in the nonparity plan. It was a big deal from a research point of view."
Part of the controlled costs stem from OPM's encouragement that providers manage their mental health care. That means insurance companies can require participants to use a select group of practitioners within their network, get prior authorization for treatment and follow a set treatment plan.
In the Blue Cross Blue Shield standard federal plan, participants must get approval before they can receive any inpatient or outpatient mental health treatment. For in-network medical providers, there is a maximum of 25 visits a year and practitioners must provide a treatment plan by the ninth outpatient visit. There is a $15 co-pay for each visit to social workers, psychologists or psychiatrists. Inpatient visits have a $100 co-pay.
Legislation has been introduced multiple times to extend the level of parity granted in the federal program to private sector insurance plans, but has never passed.
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