Five Questions With: Ruth Feder

On Dec. 6, the Mental Health Association of Rhode Island launched its RI Parity Initiative, a statewide public awareness campaign to educate and empower people to understand and assert their rights to health insurance coverage for mental health care, including addiction and treatment.

Ruth Feder is the executive director of the MHARI. She previously worked as an attorney for the state of Rhode Island’s Office of the Mental Health Advocate. She holds a master’s degree in social work from Boston University and a Juris Doctor degree from Suffolk University Law School.

Providence Business News spoke to Feder about mental health care in Rhode Island and the RI Parity Initiative.

PBN: Your campaign for parity announcement mentions a lack of in-network mental health providers. Is this a supply problem, or an administrative problem? 

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FEDER: Both are a problem. With respect to child psychiatrists, there is, in fact, a shortage in Rhode Island, and elsewhere. But network adequacy is a significant part of the problem and is an issue of parity. For example, psychiatrists who treat adults often choose not to participate in health plans because of a combination of low reimbursement rates, over-complicated credentialing requirements by insurers and burdensome paperwork.

A November 2017 national report across all states by Milliman found that mental health professionals were reimbursed at significantly lower rates – 17-22 percent lower – than physical care specialists for comparable services. Weak insurer networks force patients to pay out of pocket and wait for reimbursement. Many can’t afford that. And, often times the reimbursements are denied.

PBN: Your statement notes other rights people have to mental health care under parity laws. Can you outline them?

FEDER: Parity means equality. So, mental health parity means that, with some exceptions, health insurance coverage for mental health services, including addiction, must be the same as coverage for other medical conditions.

There are both federal and state parity laws. For types of insurance that are covered by the state parity law, there are protections beyond the federal law. In the federal law, parity is required if mental health and substance use disorders are covered. For insurance that is covered under state law, mental health services, including addiction, must be covered. For insurance plans that are covered under state law, there can be no annual or lifetime limits on mental health, including addiction disorders.

Financial requirements, [such as] deductibles and copayments, and treatment limits, such as a maximum number of visits per year, must comply with a formula that is set out in the law to make them comparable to what exists for other medical conditions. Policies that impact access to care – for example, the criteria to determine that something is medically necessary – cannot be more restrictive for mental illness, including addiction, than for other medical conditions.

When it comes to claims denials, every person has a right to appeal, but parity laws go further for mental health. A patient, or their provider, can request the full claims file, including the criteria that was used to decide the claim and how it addresses parity requirements. It is complicated, but there’s help for people in figuring it all out.

Rhode Island has a health insurance consumer hotline that is housed at the R.I. Parent Information Network. Their call center can help any Rhode Islander with any health insurance problem and it’s free. The hotline number is (401) 270-0101. And, of course, we encourage people to visit

PBN: Why is mental health care so difficult to secure insurance coverage for? Is it particularly expensive? Is it a part of health care that is easily overlooked?

FEDER: It really is because of the larger social stigma associated with mental illness and because of a lack of understanding about the brain and mental illness. But the fact is that mental illnesses are no less real, no less serious and, often, no less lethal than other medical conditions.

PBN: How much, if at all, does this problem intersect with the opioid-overdose epidemic?

FEDER: There is a significant overlap. The more barriers that there are to care, the less likely people are to pursue treatment. Barriers may exist in the form of extensive out-of-pocket costs, difficulty finding an in-network provider, challenges navigating the system, and so forth. So, for those who are suffering from an addiction disorder or are starting to self-medicate for an untreated mental illness, accessibility and affordability of treatment are imperative.

PBN: Please share a story that best illustrates this issue in your mind.

FEDER: As a part of the RI Parity Initiative, we hosted a series of focus groups with health insurance consumers. The most common terms they used to describe their experiences in trying to get their insurance to cover mental health treatment were “complicated” and “frustrating,” but also “demeaning,” “embarrassing,” and “disempowering.” MHARI wants to change this. Our goal with the RI Parity Initiative is to arm Rhode Islanders with the basic knowledge of their rights to parity, how to assert those rights and where to get assistance to assert them, if needed.

Rob Borkowski is a PBN staff writer. Email him at