A couple in Illinois recently had to hand over the custody of their adopted son to the state. The reason? They could not pay for the child’s worsening mental health condition, which was costing them close to $100,000 per year.
This was in spite of an existing private insurance and Medicaid coverage as a virtue of the adoption.
As early as 2001, more than 12,000 families had to take similar decisions across the United States.
If parents in first-world countries are suffering from the brunt of psychiatric bills, it’s only common sense that India, too, needs a fix.
Well-qualified clinical psychologists and psychotherapists in India can charge anywhere from Rs 700 to Rs 2,000 for every sitting of 45 minutes.
A 2017 study by specialists from AIIMS Delhi and the Jawaharlal Institute for Postgraduate Medical Education and Research, Puducherry, sought to find the direct costs for out-patient treatment services of schizophrenia, unspecified nonorganic psychosis, bipolar disorder and recurrent depression.
On average, it was discovered that the costs for each of the illnesses ranged between Rs 700 and 800 per month, while the participant’s mean monthly per-capita income was a mere Rs 1,680.
Another 2006 study published in the Indian Journal of Psychiatry found that lower-middle-class families (with monthly income < Rs 10,000) were paying more for the medication than they were for consultations.
The amount ranged around Rs 300 or more per month for patients with bipolar disorder and schizophrenia. For families with a meagre income, such expenses weigh very heavily.
The 2017 Mental Healthcare Act called for insurance companies to accommodate mental health expenses into their provisions.
Consequently, in an August 2018 circular, the Insurance Regulatory and Development Authority of India (IRDAI) instructed insurance companies to extend services for the treatment expenses of mental health issues.
What IRDAI did not do, however, was define what “mental health” means.
Perhaps it will be better for IRDAI to have a standardised clause for what mental health encompasses and which conditions should be insured. This will allow insurance companies to act quickly and efficiently.
Another concern is that there is no compulsion for insurance companies to extend blanket coverage on mental health concerns to their customers. Even for physiological concerns like heart disease or cancer, certain insurers refuse to cover the costs, because of the complicated nature of these conditions and the increased in-patient as well as out-patient costs.
Therefore, there is no guarantee that there will be a general acceptance of IRDAI’s instructions among insurers.
It is also known that a standard insurance policy pays for in-patient hospitalisation but not out-patient expenses like doctor visits and pharmacy bills.
This means that a similar insurance policy for mental health will be largely futile since most people do not require hospitalisation but just consultations and medication, which will not be covered.
Accordingly, insurance companies must include out-patient costs as well.
However, in spite of the hiccups, this landmark event has allowed for developments. Varun Gera, founder of HealthAssure, made a very interesting observation when he said that insuring mental health will “place mental health treatment at par with physical health”, thereby attacking the stigma that surrounds mental health and prevents people from seeking help.
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Hopefully, insurance policies will become robust in the years to come, which will allow people to seek help for their mental health concerns, secure in the knowledge that they are covered. Neerja Birla of Mpower believes that “premiums are likely to be higher for mental health insurance policies”.
Nonetheless, the goal is very achievable for insurers, and one can hope for it to become a reality in the near future.
(Written by Shivangi Singh & Edited by Shruti Singhal)