Sometimes the little things are a really big deal.

I’ve been working on an article on the impact the Affordable Care Act will have on those of us with mental illnesses. I have been focusing on the big picture – no more denials for pre-existing conditions, parity coverage for mental illnesses and children up to age 26 staying on their parents’ plan. These are the big ticket items that will have big impact.

Under the ACA, you cannot be denied coverage because of your diagnosis for bipolar. You cannot be charged higher premiums or co-pays because of your history of depression. Your insurance plan will pay for your 23-year-old daughter to go to rehab.

Then I learned about a little thing that has not grabbed headlines but will have a profound impact on people with mental illnesses. It’s about the online directory of providers that insurance companies provide for consumers who are shopping for insurance.

Doesn’t sound like a big deal. I would have glossed right over it if it hadn’t been for Dr. Steven Daviss, Chair of the Department of Psychiatry for the Baltimore Washington Medical Center of the University of Maryland.

As part of the Affordable Care Act, insurance companies who want to participate in health benefit exchanges will be required to provide an accurate, up-to-date online list of mental health providers, Daviss said. The insurance companies will have to list practitioners who are currently accepting new patients and the contact information for those providers must be accurate.

“For me, one of the issues that is an ongoing problem, and I think the biggest problem in behavioral health, is the insurance directories they use,” Daviss daid. “You look at this nice long list but when you actually try to get a doctor, you can’t find somebody. The lists are typically inaccurate and include wrong phone numbers.”

Daviss was enraged last week when he saw a list that contained the names of four people at the hospital where he works that have not worked at the hospital for at least three years. Yet, there they were, listed as both in-patient and out-patient providers.

Sounds like a little thing, but here is why these online directories are a  really big deal:

Imagine a savvy consumer looking for medical insurance with behavioral health coverage does her due diligence and goes online to see how many behavioral health providers participating in the plan are accepting new patients. She wants to make sure that if she needs a psychiatrist or therapist, she will be able to find one who participates in her plan. She sees a nice long list of providers and decides to buy you the plan.

Then, when she is in the throes of a major depression or an acute anxiety episode she calls one of the psychiatrists only to learn the number has been disconnected. She calls another and the doctor has retired. She calls another and the doctor no longer participates in the plan. How many more calls do you think she will make before giving up?

Of course, the effectiveness of any of the provisions in the ACA depend on how the new regulations are implemented and enforced. That remains to be seen. But we must sweat the little stuff, like these online provider directories, because sometimes the little things are a really big deal.