The article below is just another example of the devastation that is caused by the unequal health coverage for the mentally ill by insurance companies. I, myself, filed for bankruptcy over a year ago. By the end of finally filing I owed about 60 creditors and was up to 50,000 in debt. This is because I was hospitalized 11 times in 18 months for mental issues. I’ve been unable to work since this time and am still working to reach a full recovery and return to work. I’m lucky to be on Medicaid. But I want to go back to work. In order for that to happen I must recovery fully. Currently I’m still on a lot of medication that costs over $800/month. I need to be able to function without so much medication. Currently, without my medication, I would live in a state hospital. The premium for my drug prescription plan costs me $90/month. If it wasn’t for the community center in my city I would be expected to pay 300 per month before Medicaid would pick up anything. I’ve been very fortunate to find therapy that goes by a scale that is income based.
I am very, very blessed. But, what would I do if I didn’t have this help? It really is scary. Because I know there are many who don’t. They end up homeless. They end up addicted to drugs and alcohol in an attempt to self medicate their symptoms. This is not the case for all drug addicts and alcoholics. But for those who have mental illnesses and no health care coverage, many times it is. Its been said that prisons would have more space if this problem was taken care of also. I don’t believe that mental illness is a reasonable excuse for hurting anyone ever. It makes me sick to think of people who try to get away with murder by saying their bipolar. That’s ridiculous. However, for those who do end up as addicts, and who end up in prison from theft in trying to cover their drug habit this does make sense to me. I once took a college class on addiction. The instructor who had 30 experience in working with addicts explained that there are people who wake up every morning knowing that they have to get $200 per day to support their habit. Alcoholics and heroine addicts, for instance, can die from withdrawal. Their body goes into shock, and they don’t make it.
I am currently a member of NAMI. I’ve written congress and the Director of NAMI in my community regarding the depletion of healthcare benefits for those who depend on Medicare and Medicaid. That is all that I know to do besides urging people to vote for issues that will keep funding for Medicaid and Medicare. You may not need it now. But you will when you retire. Its interesting I’ve received letters back on other issues, but not on this issue from my state representatives.
— Joanna Doane
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news.enquirer.com: 
Mental health’s coverage crisis
Often, families with mentally ill children must choose poverty
BY PEGGY O’FARRELL | ENQUIRER STAFF WRITER
Yvetta Collins stood on the edge of a roof, convinced that jumping to her death was the only way to get her mentally ill daughter the help she needed.
Dozens of hospital stays had exhausted insurance benefits for 11-year-old Linzi. Collins made too much money to qualify for public help. She owed thousands of dollars to doctors and hospitals. And she was sure she was about to lose her job with the University of Cincinnati Police Department because her daughter’s illness took her away from work so often.
“I thought, ‘If I take myself out, somebody will have to help Linzi,’ ” Collins says.
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Collins didn’t jump that night five years ago. She couldn’t figure out how to ask God to forgive her. But the solution she reached was almost as drastic.
She quit her job and went on welfare so her daughter, who has bipolar disorder, would qualify for Medicaid. Now, the state pays for Linzi Collins’ care - more than $22,000 since last year.
Linzi is one of an estimated 430,000 people in Greater Cincinnati and Northern Kentucky who have a mental illness. Many of them - and their families - are frustrated and scared by a U.S. health insurance system that pays less to treat people who suffer from mental illness than it does to treat patients with physical ailments like arthritis and diabetes. Now, the system may be squeezing them more.
Ohio lawmakers are considering a plan that would require employers to cover at least nominal mental health costs, but a loophole would let employers opt out of that.
Anthem, the region’s largest health insurer, is cutting reimbursements to psychologists and some therapists, a move that may make it harder for people to get mental-care help.
All this is coming while patient loads are rising. Cincinnati Children’s Hospital Medical Center treated children with mental health needs for a total 29,000 patient days in the year that ended June 30 - a 66 percent increase from just three years before. At the same time, the number of licensed psychiatrists in the region has dropped slightly, to 241 this year in Hamilton, Butler, Warren and Clermont counties.
Peter Mattson, 15, of Finneytown can swing from deep depression to irrational elation when his bipolar disorder is at its worst. His parents’ health insurance covers the cost of 60 days in a hospital for Peter’s mental illness - but that’s the lifetime limit.
Peter exhausted that coverage when he was 9.
“If you have cancer, that’s caused by a defect in your body. You can’t help that. You can’t stop that. You can’t prevent it yet,” Peter says. “If you have a mental illness, we think that’s caused by a defect in your body. But insurance companies cover cancer. You can get thousands and millions and millions of dollars for help with cancer. But there’s nothing for mental illness. You can’t help cancer and you can’t help mental illness, so what’s the big difference?”
TOUGH CHOICES
Workers across the region are starting to pick among possible health plans for 2007, in the annual end-of-year exercise known as “open enrollment.” Workers with family mental health issues are especially careful.
Thirty-eight states, including Kentucky, require insurers to provide at least some level of mental health coverage. But typically, plans limit payment for mental health care to a set number of therapy visits and hospital days. Insurance might pay for an individual to have 30 mental health therapy visits a year while giving unlimited coverage for visits to a cardiologist or diabetes specialist.
Ohio does not even require health plans in the state to cover mental health, although most do.
A proposal in the legislature would require employers who offer insurance to cover at least $550 worth of costs a year to treat mental illness or drug or alcohol abuse. But employers could opt out of that coverage if they can show it would increase their costs by 1 percent.
Families of mentally ill children are often hit hardest, says Mike Sherbun, a psychologist and senior clinical director for psychiatry patient services at Cincinnati Children’s Hospital. Kids with bipolar disorder and schizophrenia, for example, often need more intensive services, including hospitalization, than adults, and can quickly exhaust mental health coverage under their parents’ health insurance plans. It’s not uncommon for one parent to quit working to care for a child.
“You have to accept that if you have a child with any kind of chronic illness in the mental health area that you’re going to be impoverished,” Sherbun says.
Families can choose, like Collins, to give up jobs and private insurance and go on state assistance, or to give up custody of their children and let the state take over their care, Sherbun says.
“That’s a hell of a choice to have to make,” he adds.
The National Institute on Mental Health estimates that one in five Americans has a diagnosable mental illness - which also is the No. 1 cause of disability.
A 1999 report from the U.S. Surgeon General found that a family needing $35,000 in medical costs to treat a physical illness would pay $1,500 and insurance would pick up the rest. A family with the same medical costs for mental health treatment would pay $12,000.
Mental health therapy can cost more than $100 an hour, hospitals can cost up to $1,000 a day, and prescriptions can run more than $100 a month.
Collins estimates that she owes $30,000 to $50,000 because of Linzi’s illness, including a car loan she defaulted on because of medical bills.
ECONOMICAL COVERAGE?
Mental and physical health have been covered at different levels since managed care came into vogue in the 1980s. Insurers claim providers abused the system by submitting false bills. But advocates for the mentally ill maintain that too many people still see mental illness as a character or moral flaw, not a treatable illness.
In today’s world, advocates say unequal coverage makes no sense.
“Mental illnesses are just as debilitating and just as treatable as any chronic illness,” says Gary Goetz, vice president of operations for NorthKey Community Care, which serves 8,200 mentally ill people in Northern Kentucky. He says it’s frustrating that people with chronic mental illness can’t get the help they need because it’s out of their financial reach.
Insurers and employers say requiring them to offer equal coverage is too expensive and could force some employers to drop insurance.
But studies show that equal coverage would increase most employers’ costs by less than 4 percent, says Janice Bogner, a program officer for the Health Foundation of Greater Cincinnati.
Some employers would see increases of only 1 to 2 percent, says Sharron DiMario, president and executive director of the Employer Health Care Alliance, which represents employer health-care purchasers. That’s a small increase, she says, but “it adds up to higher costs for employers, who already have been experiencing increases. And where do some of these increases end up? They get passed along to consumers.”
Jim Mauro, executive director of NAMI of Ohio, an advocacy group for the mentally ill and their families, says consumers already pick up the tab for unreimbursed mental health treatment.
“The reality is we’re paying for all of this anyway, with increasing costs for penal systems, ER visits, police intervention, all of those things that impact our entire society,” Mauro says. “When you get people into treatment, you avoid all of these issues that we’re going to pay for no matter what.”
OUT OF REACH
Families affected by mental illness say they’re limited, too, by the availability of care.
Anthem Blue Cross and Blue Shield, which covers 500,000 members in Greater Cincinnati and Northern Kentucky, is cutting its reimbursements to psychologists by 20 percent on Nov. 1. Reimbursements to other therapists, including licensed clinical social workers, also will be cut.
James Brush, a child psychologist in Monfort Heights, says the cuts will force him out of Anthem’s network. That means his patients who are covered by Anthem will have to find new therapists if they want to stay “in network,” where costs to them are cheapest.
But many therapists’ offices already have long waiting lists.
Paul Beckman, vice president for health care management for Anthem Blue Cross Blue Shield for Southern Ohio, says the cuts will bring area reimbursements in line with those paid to therapists in the rest of Ohio, Indiana and Kentucky. The company now reimburses psychologists about $80 for a regular therapy session; that will drop to about $60.
For Collins, the issue of equal benefits is clear-cut. She had two other jobs after she left UC, but she had to leave each one to take care of Linzi. She also couldn’t afford to keep working and pay for her daughter’s treatment out-of-pocket.
Before she stopped working, she made about $40,000 a year.
To cover Linzi’s care, Collins estimates she’d need to earn more than $5,000 a month, or $60,000 a year. Some months, when Linzi needs hospitalization, her income would have to be $10,000 a month.
Collins was desperate when she stood on that rooftop on the UC campus and considered suicide as her only option for helping her daughter. Now she credits her faith with giving her the strength to keep caring for her daughter.
She knows some people will criticize her decision to go on welfare. She and Linzi, now 16, live in a subsidized apartment in North Avondale. Their income is $900 a month, including $80 a month in food stamps.
The situation isn’t great, she says, but “we have a roof over our head. There was a time when I thought we’d be homeless. I thought we’d be down in a shelter.”
Saturday, November 4, 2006 at 2:00PM 
