By Jay Zaragoza, President NAMI Orange County

or years NAMI has had an unwavering policy of supporting insurance “parity” where mental illnesses are treated by health insurance companies like all other illnesses.  The North Carolina legislature, unlike other nearby states such as South Carolina and West Virginia, has refused to enact parity legislation in order to protect the interests of insurers and other special interests.  Even though there may be other, more timely issues of the day before us, NAMI North Carolina and all the local affiliates need to step up their efforts to pass parity legislation this year.   

Our lives changed nearly a dozen years ago when our youngest child was diagnosed with a persistent mental illness.  Our world as we had come to know it was ending and we were about to enter into a new world of medicine, doctors, doubt, fear and unanswerable questions.  Fortunately, both of our employer-provided health insurance policies covered our child whom had not yet turned 18.  All the test and medicines and visits would be covered, at least so we thought.

The promises of private health insurance began to fail soon after the tests for “conventional” illnesses came back negative.  Once the mental illness diagnosis was “ruled in” the gatekeepers at the insurance companies started to dig in their heels and resisted paying the rising number of mental illness related claims.  Our child is still covered by one of the insurance policies and we continue to submit claims, but what was once resistance is now almost total denial of coverage. 

The Social Security Administration approved SSI and SSDI payment for our child at age 21 and as a

result Medicaid became available.  However, the private insurance coverage remains the primary coverage, meaning that Medicaid is billed for those bills that the private insurance company decides it does not wish to pay.  However, as best as I can understand the system, Medicaid says, in essence, that if the insurance company does not feel the bill should be paid, then why should Medicaid?   This happens frequently.

Medicaid alone is not the answer either.  We continue to insure our child because of the gaps in conventional illness coverage under Medicaid.  Also, it is our hope that one day our child will no longer qualify for Medicaid and will then need private health insurance.  But that does not mean that our child will be able to obtain health insurance once off Medicaid.  Hence, we cannot allow the private insurance to lapse.

Will insurance parity be a panacea?  Probably not, but even a less than perfect parity plan will be a significant benefit to those with private health insurance.  It could even lessen the burden on the State’s taxpayers who pay for the cost of Medicaid in state and federal taxes.

Jay Zaragoza can be reached at k1ywy@aol.com