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Insurance Loopholes

Terry McLeod Updated: Jul 13th 2010

Is it possible our local neighborhood insurance professional wants to discriminate against our neighborhood mental health professional?

insurance policy documentIn high school (about a hundred years ago, it seems), I recognized that the insurance industry had possibly the strongest, best organized lobbying effort in the country. In that industry's defense, a regulated industry needs friends in high places, or a lot of employees and executives would not be able to pay the bills, send the kids to college and generally live the American dream.

On the other hand, the push-pull of our system encourages the search for loopholes whenever a law is passed that is intended to better the lives of folks needing help. A few laws have come to the books lately, and one under attack by the insurance industry is the Wellstone/Domenici Act of October, 2008, "Mental Health Parity".

Mental Health Parity is meant to assure that people working in mental health and addictions treatment get paid on a like-basis as physical health services. Traditionally, mental health practitioners have had a tough time getting services authorized and paid by insurance companies, and some avoid dealing with insurance altogether. This hurts the practitioner who needs to make a living, and the consumer who needs help with mental health issues. Higher insurance co-pays and deductibles for mental health services and limits on services were common prior to mental health parity. This law just came into full effect recently.

With billions of dollars at stake, the fight is on. The National Council says lobbyists working on behalf of the insurance industry are undermining Mental Health Parity.

The essence of the issue is discrimination, not just against mental health professionals, but against consumers who need help with mental health and addictions issues. A licensed mental health practitioner, a psychologist or psychiatrist puts a significant chunk of change into their education in order to engage in a profession of helping people. If I want to help people and have a choice to spend what could be eight years or more of my life pursuing the education to do that, I might swing toward physical health if the paycheck were to be significantly bigger. The dollar bill could rule my decision, even if I am better suited and my passion is directed toward mental health and addictions treatment. Under circumstances like this, consumers lose.

Lines are being drawn over this issue on Capitol Hill and people are choosing sides: the insurance empire, or the people who help folks with mental health or addictions disorders. We don't have to choose a side or do anything…but we could.

I recently cited a New York Times article on this subject, in which the insurance industry's side of the story was made clear. The following day, an interesting letter to the editor was published. The National Council's Chief Executive, Linda Rosenberg weighed in with a very important fact: suicides and incarcerations were the out come of some denials for access to mental health and addictions treatment.


Terry McLeod

Electronic Health Records (EHRs) are a required part of our society, and improving business workflows with the EHR is imperative for the survival of your local mental health and addictions treatment clinics. Terry McLeod provides the bridge between the mental health and addictions professional and the technical world, as well as the glue to keep it working. Contact McLeod at and get more information from his website and blog,

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