Press-Republican

FYI...

March 2, 2014

Does your insurance plan cover self-inflicted injuries?

(Continued)

Mental health advocates and government experts point to the HIPAA rules, noting that source-of-injury exclusions aren't allowed if they're the result of a medical condition. So if someone is severely depressed or suffers from another mental illness and sustains injuries from a self-inflicted gunshot wound, for example, the health plan can't deny claims, these experts say, if the plan would generally cover the treatment for gunshot wounds that were not intentionally self-inflicted.

Further, the 2006 regulations "make clear that such source-of-injury exclusions cannot be imposed even if the mental health condition is not diagnosed before the injury," a Department of Labor spokesman said in an e-mail.

Roughly 38,000 people commit suicide annually, according to the National Institute of Mental Health. (For every suicide death, there are an estimated 11 attempted suicides.) And more than 90 percent of people who die by suicide have a mental health condition, said Jennifer Mathis, director of programs at the Judge David L. Bazelon Center for Mental Health Law.

While the HIPAA nondiscrimination rules apply to all employment-based health insurance, the new federal health law has extended those rules to the individual insurance market.

Some plans offered on the health insurance marketplaces contain source-of-injury clauses, said Carrie McLean, director of call centers at eHealth, which sells health insurance online.

Some exclude coverage of injuries related to suicide in all cases, while others make an exception for mental illness, she said.

Under the federal Mental Health Parity and Addiction Equity Act, health plans generally must provide mental health and substance use disorder benefits that are comparable to benefits for medical/surgical care. But if a plan denies coverage following a suicide or suicide attempt, it's probably not a parity issue because patients generally would require medical or surgical care to treat physical injuries rather than therapy or other mental health services. according to the Labor spokesman.

Questions about suicide exclusions in individual market plans should be directed to the state insurance offices or the federal Department of Health and Human Services, according to the Labor spokesman. Someone enrolled in a group plan may file an appeal with the health plan.

 

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