OCD, Mental Health, and the National Health Care Debate

Friday, September 25th, 2009 Obsessive-Compulsive Disorder (OCD)

Recent months have seen an enormous amount of discussion on the issue of developing a national health care plan. This issue has become a lightning rod for activists on the left and right, and promises to provide ongoing debate for months to come. One part of this story that has not received much discussion in the media is how a national health plan might address mental health care.

As many of our clients with OCD and related anxiety-based conditions know, insurance companies in California are not eager to cover the costs of treatment for those who seek care for these disorders. Simply put, insurance companies are large corporations and have as their primary goal to increase their profits. As such, they naturally make efforts to avoid reimbursing their subscribers.

To address this problem, the State of California legislature crafted and passed a bill in 2000 which mandated that insurance companies offering insurance in the State of California must provide coverage for nine specific mental health conditions. Among these nine conditions were two disorders that we regularly treat at the OCD Center of Los Angeles – Obsessive-Compulsive Disorder and Panic Disorder.

This law, known as the Mental Health Parity Act, has very specific provisions regarding mental health coverage which mandates that insurance companies “shall provide coverage…under the same terms and conditions applied to other medical conditions” and that “the terms and conditions ..that shall be applied equally to all benefits under the plan contract, shall include, but not be limited to, the following:

Maximum lifetime benefits.
Copayments.
Individual and family deductibles.”

In other words, insurance companies must provide coverage for the nine mental health conditions covered by the law, and are legally prohibited from setting different benefits, copayments, or deductibles for these conditions. Period.

Unfortunately, despite the fact that this bill passed into law almost a decade ago, the practical reality is that insurance providers continue to do everything they can to avoid paying for the treatment of OCD, Panic Disorder, and other conditions covered under the law. The most insidious method by which insurance providers get around this law is to write policies so that behavioral health care is essentially covered in a separate sub-policy, thus getting around the requirement that a policy must cover these conditions with the same benefits, copayments, and deductibles as they cover other medical conditions. The end result is that insurance companies offering policies in California often avoid providing full coverage for OCD, Panic Disorder, and the other conditions covered by the law, despite a legal requirement to do so.

If the national health care debate is to be serious, then we as a society, and our legislators in Washington, must discuss the importance of providing fair and equal coverage for every individual who has a psychological condition. Recent research has found that many psychological disorders, including OCD, Social Anxiety, Trichotillomania and others, have genetic bases, as well as other measurable biological causes (i.e., strep infection-related OCD). It is time we started treating mental illness as just that – illness. And as such, mental illness should be fairly and equally covered in any national health care plan.

•Stacey Kuhl-Wochner, LCSW, is a Licensed Clinical Social Worker at the the OCD Center of Los Angeles, a private, outpatient clinic specializing in Cognitive-Behavioral Therapy (CBT) for the treatment of Obsessive-Compulsive Disorder (OCD) and related conditions. She can be contacted stacey@ocdla.com.