Tuesday, January 27, 2009

Department of Insurance NC suggests I could obtain a BCBSNC group policy for my three family members

I had enquired of The NC Department of Insurance as to why my BCBSNC Advantage (!!!!) plan benefits indicated that my mental health benefits were to be paid at 50% reimbursement instead of what I had believed was state law re: mental health parity. I was wrong; mental health parity laws in NC (and I betcha! federally), do not cover families who buy their own expensive health insurance.

There are more than 2.5 million people in NC who have the same kind of insurance that I have.

Because I have an individual plan (my family of three), I do not get this benefit. So, my family pays $750/ month for three healthy individuals and I do not get:

screening colonoscopies
diminished mental health benefits

But I got free medications yesterday!----which would have cost me about $40 out of pocket!

I'm gonna go ask BCBSNC if they can create a group policy for three people, as suggested by the Department of Insurance. I'm sure that will be no problem at all.

I'm gonna do that today and heck, I'll just suggest to my impoverished patients on Medicaid and letem know that all they need is a different frame around their reference points. Why, you could go get a full-time job! Who needs a disability check? Here: I've got the newspaper and we can look thru the want-adds just for fun.......

Or maybe that psychiatrist in the School of Medicine over in Chapel Hill who advocated in his opinion piece that gee, let's just all get some good mental health this year----that should be our goal this year----to which I responded: ahem: one of the matters usually associated w/ mental health is having a job. If people who receive SSI checks cannot work more than about $200/ month or less without wrecking their checks and their lives----and if no one is hiring part-time and if you can't get to health insurance if you are part-time.....

Aw, forget it. Just get a new frame; just go create that group policy for three people in a family.

January 27, 2009

Dr. Marsha Hammond
RE: File Number. 2009-01-01501
Mental Health Parity NCGS § 58-3-220

Dear Dr. Hammond:

Your correspondence to Representative Verla Insko has been forwarded to the North Carolina Department of Insurance since your inquiry pertains to insurance laws regulated by this department.
The legislation regarding the Mental illness benefits coverage can be found in North Carolina General Statute 58-3-220. I have enclosed a copy of this statute for your review.
Review of the information provided indicates that the coverage in question is the Blue Advantage Plan issued by Blue Cross and Blue Shield of North Carolina. The Blue Advantage plan is the individual plan that Blue Cross issues, and therefore does not fall under the attached statute regarding mental health benefits, as the statute only pertains to group coverage. Mental health coverage for the Blue Advantage Plan is as stated in the policy contract. Group plans can range from 1-49 for small employers and 50 and up for large employers. No matter the size of the group, the mental health benefit requirement for group coverage remains the same.
We hope you win understand that our legal authority in such matters is limited to ensuring the company complies with the terms and provisions of its policy contracts and complies with relevant insurance laws and regulations.
I regret our efforts did not produce a more satisfactory resolution for you. If you have any questions or if we can assist you on any future insurance related matters, please contact us.

Nichole Faulkner, PCS,AIRC,ALHC,FLHC (sure a long list of expertise; what in the world do those stand for? I have no idea)
Insurance Specialist 919 807 6774


§ 58-3-220. Mental illness benefits coverage. _
(a) Mental Health Equity Requirement. - Except as provided in subsection (b), an insurer shall provide in each group health benefit plan, for the necessary care and treatment of mental illnesses that are no less favorable than benefits for physical illness generally, including application of the same limits……

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