Faenza: Most differences are due to the purchaser. They--not the managed-care organization--typically make decisions about coverage. The most common mental-health plans cover 30 inpatient days and 20 outpatient visits, with copays and deductibles higher than for the treatment of physical illnesses. Coverage becomes irrelevant, however, if you cannot get care approved.
What approach to coverage do you recommend, and how does it differ from existing coverage?
Dixon: Substance abuse and mental-health treatment should be covered on par with physical health-care benefits.
Faenza: NMHA recommends flexible benefits without limits for each treatment setting. Because a managed-care provider only authorizes treatment it deems medically necessary, further limiting care by setting is neither cost-efficient nor clinically effective.
Is the system preventing people in need from obtaining help?
Dixon: Managed care as a barrier to access is a myth. Just call us. Accessing a level of care that you don't need isn't a service to you nor to your employer--or the taxpayer who picks up the tab. Typical in this regard are stressed-out parents who want to pack off their very disturbed adolescent to some camp in Utah for two years at the cost of $500 per day and don't understand why we think there are better and less-expensive alternatives. In the midst of their understandable despair and frustration, they reach for a lawyer to hammer us, instead of calling sooner. Beyond calling us, I think we've only just begun to explore the potential of the Internet to empower consumers. Our charge is to eliminate the need for "navigation" entirely.
