Is health insurance appropriate? The debate over mental health coverage

Insurance market players have backtracked on claims in a new Consumer magazine article criticizing the industry for “inappropriate” practices and arguing that mental health should be excluded from insurance policies in the United States. As a symptom of “systemic failure in the insurance market that can be attributed to the cause. Of health.

Friday, April 21st 2022, 6:51 PM

and Jenni McManus

The article, written after what Customer described as a “hide-and-seek” of 14 stimulants, he was critical of so-called blanket exclusions for reporting mental health conditions at the time. mental health is “a widespread problem in New Zealand”.

“There is a difference between how the public thinks about mental health and how insurance companies apply it to their policies,” the article said. He also accused insurers of taking different approaches to mental health coverage, with some limitations and exceptions and others, saying, “you can afford it. . “

But insurance players say while they improve Customer As for the mental health of New Zealanders, they did not believe that his report accurately reflected the nature of the region or the progress that had been made in this area.

Richard Klipin, director of the Board of Trustees, said he was disappointed Customer Did not test the suppliers ’products and go through the underwriting process or accept how underwriting has changed over the years.

“It’s kind of weird to think that there are so many mental health interventions and actions that our members have done to address mental health, more of them than what’s been caught. in a policy document, ”Klipin said.

He said underwriting is an important part of the insurance process and hopes to achieve balance between different groups of customers with different personal characteristics. “While mental health problems are covered by various insurance policies, it is important that these problems are understood and taken care of.”

The counselors spoke Good return to say that the process is more nuanced Customer opinion. For example, the client’s health records are not only thrown out at the author’s door: but the consultant goes through the review through the client’s health history and explains areas of concern. nei.

Mental illness, or any previous illness, can become a problem depending on the type of coverage sought (e.g. health, trauma, serious illness, financial management etc.).

It also depends on how the situation plays out. Is it a single moment of mental illness or is it coming back? Was it about a special event like the death of a loved one? Is the customer on medication? When is the last time?

Health care policies in New Zealand are about coverage for medical conditions. Most importantly, they are designed to provide coverage for unforeseen events that are to come, rather than normal or perceived.

Most of the testers clearly stated in their policy that mental health conditions would not be covered if someone offered to pay for minimal psychiatric care if required after surgery. The important thing here is that mental health is related to a physical condition.

It is not a mental health mask that is available as an accessory to the guidelines, like a dental mask or optical mask. The exceptions are Southern Cross and nib, which started offering holders a gold standard covered policy (around $ 2500 per year) for psychiatric and psychologist consultations.

On their websites, the two experts see good mental health as an important part of well -being. Nib said up to 80% of New Zealanders experience some form of mental health problem in their lives “and it’s good to ask for help”. He describes his mental health offer as a “plus, unlimited time offer” for new (ish) customers that is not part of the claimant’s insurance agreement.

It’s a similar situation in Australia where most providers do not specify the type of mental health coverage in their policies while some, such as AAMI and nib, pay an additional $ 300- $ 400. mental health discussions as part of the “extras” section for people. adhere to health care policies.

There is no barrier to covering the first levels. Some providers may agree to cover certain conditions after a period of time, often between two and three years. But there is a group of pre -existing conditions that are not covered by most applicants and these are often found on the provider’s website: chronic illness; cardiovascular disease; knee, thigh and back problems; Cutting cutting; and redesign or repair.

The only part of the insurance industry where the focus is on the customers is financial security. Under these policies, the provider will pay 70-75% of the cost or compensation if the client is ill or injured and is unable to work. Illness can involve mental health conditions that have arisen since the policy was taken, which is why underwriting is so important to save money.

According to some advice, financial policies are simpler. Since the onset of the disease, he said, the incidence worldwide has increased by 400%. Mental health problems are, in his view, “a small part of black science”.

“How do you diagnose a mental health problem or not?” he asked. “If a person is found to be in financial trouble and has a savings policy that says they will pay him $ 1000 a week, it is easy to say that you have problems or health problems. Can’t go to work.They can’t take an x-ray of your brain and see what the problem is.

He sees a similar situation in Australia where some claimants claim permanent disability from mental illness and they use this to make financial claims on their superannuation funds.

According to other counselors, doctors need to be careful about what they write in patient notes. For example, a feeling such as “worried” when a patient tells the story of an activity is important that can have long -term consequences if the patient needs health insurance.

It would be a bad thing, he said, if people were not considered to seek help for mental illness because they were afraid it might jeopardize their right to insurance. Some consumers are signing up for their children for birth health insurance to prevent future complications with the first conditions, he said.

According to Klipin, it’s important to remember that when underwriters work from a set of leaders and when it comes to insurance, there is no one-size-fits-all. Each person’s situation is unique and a good consultant can combine products to suit each person’s needs.

Underwriting has become “more important,” says Klipin, allowing providers to better understand the nature of the mental health problem the consumer is experiencing and its associated stress.

“All FSC members are working within the Fair Risk Assessment Guidelines, which define the principles of fair risk management and continue to evaluate, price and manage the risk that customers claim. their policy. “

Kilpin said many insurers that offer health care plans and programs to policyholders are free from policy deductions.

“Mental health is a serious problem and there is a responsibility for everyone to take action so that we can improve the health and well -being of New Zealanders,” he said.

“Research that isn’t about rigorous testing of the system can lead customers to be ignorant and unaware of the process. We don’t believe in that. [Consumer] the report accurately reflects the nature of the industry on this important topic.

Words: Customer FSC Healthy health Richard Klipen

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Is health insurance appropriate? The debate over mental health coverage

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