Mental Health in India: Why Insurance Coverage Falls Short.
Mental health is a vital aspect of our overall well-being, yet it remains a taboo topic in our society. The stigma surrounding mental illness is so much that it causes individuals to suffer in silence rather than seeking help.
If anyone wants to seek help and undergo therapy, the whopping charges for each session will make people refrain from seeking it.
The high fees can be daunting, causing many individuals to hesitate or altogether forego seeking professional help, despite desperately needing it.
Archana Kavi, the Malayalam actor, recently talked about this candidly during an interview while speaking about her struggles with anxiety, depression, and trauma, highlighting the importance of seeking therapy.
She stated that in India, where mental health resources are scarce, finding the right therapist or treatment can be challenging and also mental health therapies are not covered under health insurance, despite the substantial costs associated with multiple sessions.
In India, mental health insurance coverage is not mandatory and most health insurance policies do not cover mental health treatment. This leaves families and folks to bear the financial burden of mental health care, which can be crippling.
Studies have consistently shown that network adequacy for mental health treatment is a significant issue. A 2019 report revealed that behavioural health office visits are over five times more likely to be out-of-network than primary care appointments.
Similarly, a 2016 report by the National Alliance on Mental Illness (NAMI) found that individuals faced greater difficulty finding in-network providers and facilities for mental health care compared to general or speciality medical care.
Why do many health insurance plans lack in-network providers for mental health and substance use care? There are several reasons:
1. Shortages of mental health professionals, particularly in certain parts of the country.
2. Many mental health and substance use providers do not accept insurance due to inadequate reimbursement rates.
An article by The Indian Express discusses the significant gaps in mental health insurance coverage in India.
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Despite the Insurance Regulatory and Development Authority of India (IRDAI) mandating mental health coverage since 2018, many patients struggle to access crucial expenses associated with treatment.
Dr. Shailesh Jha, a psychiatrist at Delhi’s Indraprastha Apollo Hospital, shares his experiences with patients who are unable to leverage their insurance coverage for mental health treatment. “I’ve seen patients who are suicidal or require hospitalisation, but their insurance providers refuse to cover the expenses,” he says, quoted by The Indian Express.
The article notes that self-harm, attempted suicide, and suicide are often listed as exclusions in health insurance policies. Moreover, getting paid for claims related to hospitalisation due to mental illnesses can be extremely challenging.
Despite regulatory directives, mental health insurance coverage remains inadequate. Dr Shailesh Jha recounts a case where a 32-year-old suicidal patient was denied coverage due to complex policy clauses and bureaucratic delays.
Experts also point out that individuals with pre-existing mental illnesses face significant difficulties in obtaining insurance coverage.
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The Mental Healthcare Act, of 2017, ensures that coverage cannot be denied, but many patients are reluctant to disclose their mental health issues due to fear of claim denial for other illnesses.
As Dr. Jha warns, “Insurance providers may not help when needed. Patients need to be aware of the limitations of their coverage and plan accordingly.”
So, if you feel you’ve been unfairly even denied the limited coverage for mental health or substance use treatment, you’re not alone. Resources are available to help you appeal coverage denials. Consider consulting a health insurance coverage lawyer for guidance.
