Talking heads

ITIJ 198, July 2017

Dr Frances Cheng, a specialist in psychiatry at The Alpha Clinic in Hong Kong, discusses restrictions on mental health cover in IPMI policies.

Since 2012, I have worked as a psychiatrist at a private clinic in Shanghai that caters mainly for expats and ‘returnees’ (native Chinese that have spent many years living and working in western countries before moving back to China). Eighty per cent of the patients whom I have met had medical insurance through their employers. The variation in what the different medical insurance plans cover is huge, especially when it comes to mental health.

The best insurance plans are often held by corporate executives working for large international corporations, and their families. These often cover pre-existing conditions, including common mental health disorders such as anxiety and depression, and more serious mental health disorders such as schizophrenia or bipolar disorder. There is often no co-pay required from the plan holder or a small co-pay of 10 to 20 per cent. 

A common restriction on insurance for mental health conditions is a limit of 10 to 12 visits per year. When a patient is stable, this is often more than adequate. However, during periods of instability where weekly visits become essential, 10 visits are used up very quickly. Sometimes the sanctioned 10 or 12 visits include consultations with a psychologist or counsellor, so patients are often forced to either pay out of pocket for consultations or forego psychological treatment altogether. At the same time, a cap of RMB1,000 (£110/US$150) per visit is also a common restriction, which unfortunately is unlikely even to cover the cost of a consultation, let alone the cost of medications.

The most distressing cases are when patients think that they are covered by their insurance, when in fact they are not. In some cases, it is clearly stated in their insurance that no mental health disorders are covered. In others, patients are caught out by pre-existing conditions clauses, which to me seems terribly unfair, that someone who may have suffered from depression in their early adulthood would not be covered later in life. To see patients worrying about medical expenses for treatment of their anxiety and depression is heart-breaking.

The variation in what the different medical insurance plans cover is huge, especially when it comes to mental health

In particular, eating disorders such as anorexia and bulimia nervosa, or conditions related to HIV, are commonly excluded from medical insurance coverage because patients who suffer from these conditions do tend to require a protracted period of treatment, at times intensively. These can become costly for insurance companies to cover and are, therefore, often specifically excluded in insurance policies.

Customer care

Many expats are moving away from their home countries where there may be affordable healthcare, in a system with which they are familiar. My advice to them would be to look carefully over their medical insurance options as early as possible. Many policies will cover pre-existing mental health problems, providing that they have been reported when applying for the insurance. I have had several frustrated patients who did not disclose their medical conditions because they did not want their companies to know about their medical history, but found that their future medical claims were rejected because prior conditions had not been disclosed. Even if an entire company is on the same plan, employees should be told they can speak to their human resources department about their personal and family’s needs to ensure the most adequate cover. Some insurance companies are willing to provide extra coverage at an additional cost. Employees should also consider an additional insurance plan if they feel that the coverage offered by their company insurance is insufficient. This may prove to be more cost-efficient and less stressful in the long-run.

Those moving to a new country should try to ask their general practitioner, family doctor or any other specialist who has treated them to write a medical summary of their previous or existing condition. If they have a condition that requires continued care, they should be encouraged to contact their intended insurance provider before they leave to ascertain contact details for local doctors with whom the insurer has experience and whose costs they are willing to reimburse. The insurer may also be able to advise the policyholder of clinics or hospitals that offer any potentially required services within their reimbursement range.

Being unwell in any country is always a misery, but with careful selection of a good insurance policy, and a good understanding of their coverage and the resources available to them, the whole process of receiving treatment abroad can be much less taxing for expats and international travellers.