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Professional News
 DOI: 10.1176/appi.pn.2013.4a25
APA, Connecticut Psychiatrists Protest Insurer Practices
Psychiatric News
Volume 48 Number 7 page 14-14

Abstract

APA and the Connecticut Psychiatric Society say Anthem’s reimbursement policies are forcing psychiatrists to deny patients psychotherapy or provide it at no cost.

Abstract Teaser

APA, the Connecticut Psychiatric Society (CPS), and the Connecticut State Medical Society are protesting what they say are violations of federal and state parity laws by Anthem Blue Cross Blue Shield of Connecticut.

In a joint letter last month to the company, the three associations said Anthem’s implementation of new CPT codes increases the financial and time burden on patients who seek treatment from psychiatrists and discourages psychiatrists from providing psychotherapy. They maintained that Anthem is violating the Mental Health Parity and Addiction Equity Act, the Connecticut Parity Law, HIPAA, and the Unfair Insurance and Unfair Trade Practices laws as they pertain to the treatment of patients with a mental or substance use disorder.

Specifically, the groups said Anthem has responded to recent changes in CPT codes for psychiatry by covering only patient visits that are to be reported for medical evaluation and management while not covering psychotherapy as a separate and equal payment category. In addition, they stated that there is a significant disparity between reimbursement rates Anthem is paying to psychiatrists and those paid to other medical/surgical network providers.

Noting that beneficiaries pay for Anthem coverage with the understanding that they will have equal coverage for psychiatric services, CPS Executive Director Jacqueline Coleman said in a statement, “We will not allow insurance companies to deny coverage that patients and their employers have paid for, nor will we ask psychiatrists to provide medically necessary psychotherapy for free to insured patients.”

The challenge presented by Anthem appears to be part of what may be a widening confrontation over the interpretation of the mental health parity law. In New York, the New York State Psychiatric Association is lead plaintiff in a class-action suit against UnitedHealth Group for alleged parity-law violations .

Regarding Anthem’s practices in Connecticut, APA Medical Director James H. Scully Jr., M.D., said, “These practices are both unethical and illegal. We worked very hard to enact mental health parity laws, and it is now clear that Anthem is seeking a way to avoid compliance. We are not prepared to allow Anthem to skirt its obligations under the law.”

In the letter, the three groups say that by not accepting a separate billing code for psychotherapy, Anthem is forcing psychiatrists to face the choice of denying patients a critical part of their treatment, encouraging them to seek it from a different provider at additional cost and effort, or providing it at no cost. “No other medical specialty is being asked to deny crucial treatment for patients in need or to provide those treatments without payment from the insurer,” Scully added.

Matthew Katz, executive vice president and CEO of the Connecticut State Medical Society, agreed. “Mental health parity is more than just words—it is a commitment to equality and fairness in the provision of quality mental, behavioral, and substance abuse health care services,” he said in a statement. “Coming at a time when our state is still recovering from the Newtown tragedy, it is more important than ever that those who need psychiatric services receive them, without discrimination or stigma. It is time for Anthem to act appropriately and honor its obligation to ensure access to mental and behavioral health services for the patients it insures.”

“Studies have shown that when people who need psychiatric services receive them, they have fewer general health problems and, in the long run, have fewer health care costs than those who have no treatment,” said Scully. ■

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