hi i'm carol ricard america's wellness and basset ur welcome to the well you show i'm joined by my always present co host slash guess angel torture really on baku i call the pain detective julie maddox who i call the wellness coach so diller truth is we couldn't do this show without these ladies these ladies princeton t v so if this is your first time tuning in really i spent twenty five years working in hospitals teaching people skills to live well and my idea was to come here to princeton t v do a show so that we could teach people these skills and these ladies still make the show happen so i'm so grateful to h so they don't know what we're going to talk about today and it's something really near and dear in dear to my heart and have not watched any of my other shows i actually a person living well with a mental health condition and one of the things that's allowed me to live well for so long is treatment and having access to treatment and so i do this presentation and i going to do for these ladies here and i want to do it for you as  parity so kind of making the comparison to the good anyway in america and so here's here's what we're going to do we're going to these ladies don't know what but i have you guys my little home made my little home bodied one for you and one for you and what i would like you to do when i want to even have these for people afterwards is answer this question really what i want to do when is time that we have together is help you all and whoever's watching understand this magnificent law that we have available to us especially at the times were in this crisis you know because getting people into drug treatment is been a real challenge as well and this law is his big umbrella so it by the time we get done my goal is you and people watching will have an understanding of what it is and really how to gain access to treatment that maybe people haven't been able to gain access to before so you know this kind of educational stuff i just always have to do this disclaimer i don't not a lawyer i just play one on v but i don't even do that and so and i want to invite you to answer we have a true false questionnaire and i wanted to just go through these and ask you guys to see what you might already know ok it's for your  next one is an insurance plan is allowed to set a high co pay for psychiatric medications and again might be guessing that's good oh yes an insurance plan is allowed to have a separate deductible for mental health the first step to filing an appeal is to file a complaint with the federal government two or false and the last one is parity means people have equal benefits for physical and mental health and you can you can set that aside and we're going to kind of revisit that later but i don't know if you guys know this but a long time ago when i first was diagnosed with a mental illness it was twenty five years ago and believe it or not back then there was discrimination by insurance plans against people with mental health issues i don't know if you know julie you ever experienced out with anybody or knew of that with their body but insurance plans flat out do used to discriminate against people like myself with mental health benefits and so what happened is in two thousand and eight there was a swathe it was passed and it was called the parity law it was the it was the mental health parity in addiction equity act of two thousand and eight basically don't have to know that but what it said was now that our physical health and our mental health actually had to be treated equally you know that in the past what they were able to do for my mental health to kind of discriminate against me basi and i was going to i forgot my apples because it basically said that our physical health and our mental health had to be apples to apples that's what parody means equal to that's what the word means parity is equal to and what the law basically said was that planes couldn't be more restrictive in around visits and anything with their mental health as it were for your physical health so i to write this word up because the word actually means equal and so so let me ask you a question have you had any had to go for any tests and had to pay a co pay you know for like a medical test or a follower yeah yeah yeah well one of the ways it used to happen in the past is that they used to charge you more for mental health services than they did for your physical health services so if it was some kind of blood test they did now so so for example for my psychiatrist i actually had to pay one hundred dollars co pay to go see my psychiatrist and i only had to pay ten dollars to go see my medical provider the other way that discrimination used to happen to is it used to have a whole separate deductible and so i used to have five hundred for my medical so i would have let's say five hundred for my medical over here but i would have to meet another thousand dollars deductible from my mental health before they would actually cover anything  that was twenty five years and that what well be honest with you that was just even back in two thousand and eight two thousand and ten also before the service you know yeah so this parity law it was actually in two thousand and eight and it said that basically apples to apples or physical health or mental health have to be treated the same here's the secret oh you know if people could get away with something they do right so what happened was if you offered mental health benefits they had to be equal but if you never offered mental health benefits then the law didn't apply so guess what a lot of places did they dropped the mental health benefits so they snuck around the back door but what happened is that the affordable care act otherwise known as the a c a came along and it said that all plans that are covered by that have to provide for mental health services as well as physical health services so that now it made the law even stronger and so that is a problem because a lot of people you know don't know that insurance plans cannot discriminate against people i don't know have yet guys know of any stories of family members or friends where children or even adults have been kind of caught by this prescription you know addiction and so they start out on prescription painkillers on pain meds and then in the sifting over to actually heroin eighty percent eighty percent of heroin users today eighty percent of them started out with prescription medication prescribed by their doctor yeah i was amazed by that isis town and you know and the problem is is that you have people that go for treatment and then they get denied treatment and so what i want to help to do in our show today was really help you guys understand  so it has to be the same in number of visits it has to be the same as in co pays it has to be for the d yeah yeah yeah you know the other thing is is that to co pay it kind of has to equal out here so if i have a twenty five dollars co pay although you want to know how they do it if you guys this happens to  that and then the thing about this is if there's only one deductible anymore so that they can't have two separate deductibles for my physical health and mental health which is so amazing to me because if you think about it i think we're treating finally treating the whole person you know we didn't really realize it was like back yeah yeah in fact when i was going to see my psychiatrist that one thousand dollars was a pretty significant amount of money to me because i ended up having did get a credit card you know i remember from my medical bills my health bills because i didn't have the money to pay the deductible to where the code kicked in you know my care credit is yes very much like that where the insurer i'm sure the interest rate was like you know twenty five percent or maybe not that but and so it what it does this is says it again these have to be equal physical mental health apples to apples right but the other thing that it does is there's this other area about six categories that it has to be across so you're going to have so let's just say we're going to have inpatient you have outpatient and are you guys familiar with the fact that you can have in network out of network right right yeah and even with our outpatient we can have  network out and them work and so these are the big six it has to be even across again medications and then also emergency and so this marvelous law that we have basically says is across these areas that our physical health and our mental health have to be kind of covered the same way and as opposed to in the past where it would kind of be more like this it actually has to be kind of now more like this now it's not to say that they can't have limits so i got a good case for you so sally had foot surgery and she her  ur insurance plan and they said ok we're going to pay for your foot surgery but you have to do it in in network hospital you know and you have to do a pre authorization or  means is that if they set limits with physical health they have they can set the same limits for mental health so it's not saying it can't be limits i don't know about you all but i have limits on my health insurance oh you know going to the chiropractor you know there is kind of i think it's like twenty five visits is what i get you know which is good because it used to be fifteen so it's kind of gone up a little bit but they if they give me twenty five visits for my chiropractor then they could say to me carol we're only going to pay for twenty five visits to your therapist  know and they can set those limits but again they kind of have to be even company you know one insurance company to another they have to abide by the same this parity law it covers covers all kind of like the large group plans you know and there's a couple that it doesn't like the v a department of defense but even and medicare those kind of are like little caviar out but what's really important about this is is that for once are now actually having access to care and to treatment which is what makes losing the obamacare or or repealing you know what they replace it with just as important for a lot of people because i don't know if all know this but i understand it once in a day there were plans that would even pay for pregnancies you know were cancer treatment so they can kind of set what they're going to pay and that's what makes the current going on in our senate really kind scary because they're kind of looking at giving that sort of control back to insurance plans so that they don't they call them the essential benefits is what the affordable care act did and what it said was you have to offer you know prescription medication you have to pay for cancer treatment you have to offer mental health benefits you have to cover and it was these essential things that we all need just to live well today and that's kind of what makes that  art a little bit scary because the law in itself the federal law wasn't as strong as until the affordable care act actually made it stronger now there's really one other really important way the law has to do for people so i don't for me in my setting i would call up an insurance plan and i would say ok i got you know angel and you know she needs to be in treatment and so i want to get a pre authorized and i would give them you know say well you're sleeping all day long you're not eating and you know what they would say back to me possibly they could say carol it doesn't meet criteria so meaning they're not going to pay for it they're not going to cover it and believe it or not there are people these days that will go to a hospital for help only not to be admitted you know because it doesn't meet criteria and in the past nobody knew what it was what the criteria were yes and the funny part about it was ok so think of the wizard of oz right and the wizards hiding behind a curtain and nobody knows it seems kind a secret well that to me how insurance plans used to be they were kind of hiding behind this curtain of secrecy and they would not tell anybody it was kind of like the secret sauce you know yeah and and so people wouldn't know but what the law kind of said was now people are entitled to know why and how they're making their decisions so they call this thing medical necessity that i don't know if you've ever heard those words julie you know with your work around  medical necessity means is that it we're going to pay for it how they determine they're going to pay for everything and what they used to do is set the bar higher for mental health than again like they used to do for physical health so they'd say well guess what carol you don't need that so you got to go here we're not going to pay for you to be in a hospital or we're not going to pay for this but you have zero here and there's these different levels of treatment that they would then cut issue people to instead of your doctor deciding what it was you know it wind up being kind of light whatever you would get covered by the insurance in the parity law explains to people that you get that explanation now and you can request that information so so you can't so here's the things you can't do again has to be even the number of visits to geographic area that they cover the co pays the deductibles they all kind of have to be even and this other thing is how they decide what they're going to pay for can't be any more strict for our mental health than for physicals so again kind of this balance act so let me give you a quick example i want to give you sally her recovery action plan that we use in mental health it's kind of like think of it like as a fire drill myself personally you know like what do you do in a crisis right out like a fire or what do you do in case of fire so and what happened was she was doing really well and then she had a stroke so she ended up kind of going to see her therapist a little more often and she would see her psychiatrist so she saw four total four times a year and she all of a sudden got this letter sauced your outpatient benefits and she was devastated because she knew she needed to see her therapist she still need to do this and she was going to physical therapy now here's the thing her physical therapy they she knew they'd cover twenty six visits in a year for physical therapy when she counted up how many times she'd been to see her therapist plus her doctor it was only fourteen so my question to you well and in all fairness to insurance companies you know what some of them have been really good at it kind of implementing and but when you don't have anybody kind of even guiding you how to implement it in all fairness to them it's also there hasn't been any guidance to do that  h you know so i don't think necessarily purposely all right so here's another example aaron is a college student and he goes back to college and he goes to pick up his medication and he is actually taking a few medications of them is a brand name the others are all generics and when he goes instead of it being thirty dollars that next year it's one hundred dollars that he has to pay his co pay for his medications well now we're back to before this parity yes and what's really important for you guys to understand is that the parity law doesn't say plans can limit their co pays i don't know if you've had it that change on you where they've kind of increased i'm a little bit and you have these different pace have different tastes and so honestly that's why this whole issue will round insurance plans and what seniors have to pay for their co pays there's some legislation in other countries and other countries other states it's called capped the co pay because unfortunately plans can do that they could say all right we're going to make you pay fifty dollars now for the same medicine physical or mental health doesn't just they discriminating it's just they don't they can do that and that's really sad because when you're a senior on a fixed income it can afford that jump and jump and jump but can i tell you one of the other important things about the  yeah yeah so i mean it's really amazing when you think about how that like in the affordable care act is like really done right yet when you was it you know your own son now i want to talk about let's say you figure out ok something's fishy here carol what do i do all right and again i want to give you guys a sheet because we have to start kind of standing up for ourselves and if you never say anything then guess what so there three steps to if you've been denied treatment and you think you have a right to treatment all right there's a process step one is you want to gather info and what that means is you get all your stuff know so you're gathering information and then what goes on the step number one but again look at me i'm right to step number ones but before we go to step number two one thing i want to say is it we can appeal this verbal e and i want to give you and people an idea of how to do this so i call up my insurance plan i'm sally and they say exhausted so i call up my insurance plan and i say hi my name's sally i'm a little confused because i got this letter saying that i've exhausted all of my mental health benefits for outpatient but i know that i can get twenty six visits to see my physical therapist and when i counted up my mental health outpatient visits it's only been fourteen and i believe that this is a parity issue who can i talk to about that simple as that yeah yeah and a lot of times  provider you know to write a letter to follow up be a kind of do your appeals the written appeal you send it in put all your papers together send it in all right and you actually have to take action and the third step is this once and that is zero give up don't give up keep on fight you know because there is this thing even if our plan comes back every state has what they call an outside review and what that means is that something other than the playing is going to take a look at the circumstances and it's kind of like arbitration you know how you have like this objective third party and so these outside reviews i know one woman who's cancer treatment so works for mental health and physical so i was like i'm paying this i call the trans company and somehow just from the phone call like whoa whoa we view this and it honestly angel i think that that is such a great example too because we're talking about i'm talking a mental health but the same stuff applies to physical well you know if you've been denied treatment or coverage of a thing or you get a four thousand dollars bill then you're like what the heck and let's kind of thing all it's not the first time that happened even if you don't speak up because the same time right when i was s in lake tahoe and i got the ambulance bill and so it was just like the insurance was like you have to pay this whatever three thousand dollars and i didn't give up yes yeah i think that this is important and the other thing that i wa everybody knows even if this person comes back you can still you can file a complaint with your insurance commission you know here in new jersey it's the division of banking and insurance you can the state attorney general  the other thing that i actually is the department of labor you know that we can and there's some great resources on this sheet that we're going to put up for people because this this we have to become our own advocates and we have to kind of if we don't speak up then you just kind of it just starts to bury you quite honestly and personally get so buried in medical bills and in fact here all right so picky pieces of paper of take your little one turn it around and and from zero to five answer your question the same i have an understanding of what parity is circle where you are right now absolutely and how do identify a parity issue so how would you know you know whether or not it was or not circle where you are ok good because that means i was trying to do this without power here you're so right there is really hard to do without powerpoint but what i want to do is give you guys this handout and this is what we'll have up so depression and bipolar support alliance is who has put together th great resource and who actually has me go out and do presentations so if anybody watching this video wants to have a group come do a live presentation for free but on the backside which really important is it