Changes in Behavioral Benefits

You aren’t imagining things. A 1997 Hay Group report showed that behavioral-health-care benefits have become much more limited since the advent of antidepressants and managed care. In 1988, 38 percent of behavioral plans imposed a limit on the number of days that depressed and/or suicidal patients could spend in the hospital. By 1997, deadlines were imposed by 57 percent of plans. The number of plans imposing any mandatory checkout date for inpatient psychiatric care rose from 63 percent in 1990 to 68 percent in 1997.

    Limits on traditional “talk therapy” also have changed. Twenty-six percent of these plans imposed a limit on annual visits in 1988. In 1997, restrictions on Woody Allen-type treatments were imposed by 48 percent of plans. In addition to an increase in the number of plans imposing a limit, the limit has decreased. In 1988, 46 percent of plans restricting trips to the couch allowed a maximum of 50 visits. In 1997, the most prevalent cutoff was 20 visits.

    In addition to annual-visit limits, many plans imposed monetary ceilings. In 1988, 45 percent of plans did so. By 1997, the percentage of plans imposing these had decreased to 40 percent. However, the dollar amounts allowed by plans didn’t keep pace with inflation. Most plans imposed a limit of $2,500 or less in 1988 and in 1997. To keep pace with inflation, that $2,500 in 1988 would have had to be increased to $4,993 in 1997.

    Since then, with the advent of disease management, hospitalization and outpatient benefits have dropped even further. And, in sync with the current economic slowdown, about 10 percent of health plans don’t include behavioral-health coverage at all.

Workforce Management, September 2003, p. 58 — Subscribe Now!