The Hidden Costs of More Screening for Postpartum Depression

The screenings may be covered by insurance. The ramifications won’t be

The New York Times reports that, inspired in part by the newest findings of a government panel, some states are making important strides in screening new moms and pregnant women for postpartum depression — which, despite its name, can also show up well before the baby does. The issue affects “an estimated one in seven postpartum mothers, some experts say,” which means it is making millions of families nationwide miserable.

The panel gave its recommendation, which was published in the journal JAMA, a “B” rating, which means depression screening must be covered under the Affordable Care Act.

For years, obstetricians and other health care providers who saw women during and after pregnancy often felt ill equipped or reluctant to ask about problems like depression, anxiety and obsessive-compulsive disorder.

It’s great, even potentially life-saving, that more providers will be told to be on the look out. Maybe they didn’t feel empowered to before, or sufficiently qualified, like Dr. Suzanne Koven, who wrote this great, thoughtful New Yorker piece on her ideas about her own limitations when it came to her patients’ mental health back in 2013.

Or maybe they simply weren’t paid to do it.

The only state that requires screening, New Jersey, has had mixed results because too few treatment options have been available. While pediatricians and obstetricians were trained to screen, they were not compensated for screening, a study by Dr. Kozhimannil found.

In our country’s wackadoo fee-for-service medical model, a doctor must be able to bill for a particular action — like a depression screening — or she’ll skip it. That Obamacare will cover the screenings gives doctors added incentives to perform them. Fab. But there’s still the problem of what happens next. Talk therapy and cognitive behavioral therapy, according to the Times, can both be quite helpful. Who covers those often staggering costs? I don’t believe that even my shiny new Platinum plan does.

Not to mention that a lot of these issues can be either brought on or exacerbated by our nation’s lack of any kind of paid family leave, which can make pregnancy and early motherhood a particularly fraught, anxiety-producing time.

There are other hidden costs, too. As Ben and I discovered when we worked on securing life insurance this year, premiums go up, sometimes in quite significant ways, if you have any kind of mental health issue in your recent history, even a situationally specific condition like PPD. And yet life insurance is an especially important purchase for parents.

So, a good step forward, absolutely. But hopefully only the first of many.

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