How Are Denials of MH Care Handled?

Minnesota psychiatrists are pushing the use of APA’s practice guidelines to resolve disputes about denials of mental health care by Blue Cross and Blue Shield of Minnesota. Those disputes will be settled by a three-judge panel (Original article: see story beginning on page 1).

How are denials of care handled in the rest of the country? An article in the February AARP Bulletin presents an inconclusive picture of the effectiveness of protections for consumers in managed care plans. Forty-one states have passed laws allowing consumers to ask for an external review of an insurer’s decision by independent medical experts. Eleven states allow patients to sue their HMOs for damages if a denial of care causes harm, and 18 states have created state-funded ombudsman plans. State laws, however, apply only to individuals who are not in employer-sponsored health plans. Federal law, through the Employee Retirement Income Security Act (ERISA), governs employer-sponsored health plans.

Jill Brown, author of the Bulletin article, reported that states that have passed right-to-sue measures “haven’t seen a flood of lawsuits. . .but the threat of an expensive lawsuit can deter health plans tempted to deny services.”

What is the experience in your state? Are APA practice guidelines being used to help determine the legitimacy of denials of care? How many denials of care for mental health treatment are being reviewed by external panels? Is your state’s attorney general actively pursuing complaints about denial of care? Send your comments to [email protected].