Saturday, January 10, 2009

Against the law? BCBSNC reimburses mental health benefits at 50% and medical benefits at 80%

I just received my BCBSNC Summary of Benefits. My family of three has a modest insurance policy. For $750/ month, and a $2500 deductible, we get access to medications for a $15-50 copay; we get office visits for a reasonable fee (under $20). If we have to have surgery, mammograms, colonoscopies (covered by law! ya know), you have to meet the $2500 deductible before you can get reimbursement at 80%-----

all except mental health and substance abuse services.

My Summary of Benefits states:


"Combined in and out of network $2000 benefit period maximum per member, and combined in- and out- of network lifetime maximum of $10,000 per member, provided in all places of service. Any services in excess of this benefit period maximum or lifetime maximum are not covered services."

Covered: 50% AFTER DEDUCTIBLE In NetworkCovered

50% AFTER DEDUCTIBLE Out of Network


Summary of Benefits:Outpatient Services: 80% AFTER DEDUCTIBLE
Ambulatory Surgical Center: 80% AFTER DEDUCTIBLE
Inpatient Hospital Services: 80% AFTER DEDUCTIBLE
Maternity and Elective Termination of Pregnancy: 80% AFTER DEDUCTIBLE
Skilled Nursing Facility: 80% AFTER DEDUCTIBLEOther Services:


I dunno: print is pretty black and white. Why do my medical benefits get more extensive coverage (no $10,000 cap) versus what mental health coverage gets and why are services reimbursed at a rate DIFFERENT than the medical benefits when the state law indicates the following:


"New mental-health law to startInsurance industry must offer equal coverage

Starting today, insurance companies in North Carolina must provide the same level of coverage for some mental illnesses that they do for physical ailments.That means that someone being treated for depression or schizophrenia can no longer be charged a higher co-payment (or face other inequities in coverage) than someone being treated for diabetes or a broken arm...."


Really? I can't believe they get away with these kind of things.

Think you can get the Department of Insurance interested in these things? NAH.

Think you can get your state legislator interested in what impacts their constituents? NAH.

Been there/ done that. Shame 'em is what I have to aim for.


Blogger Tina Harkey said...

Marsha, The Department of Insurance doesn't legislate law; however, our legislators do. Call your local representatives office and ask them to draft legislation for north carolina for mental health benefits to be paid on the claim at the same rate as medical services. It's worth a shot.

12:55 PM  

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