May 24, 2010
IN THE abstract, everyone who feels the sting of rising health care premiums understands the need to hold down costs. In practice, such efforts may look to medical providers like unwelcome outside interference. The state’s Group Insurance Commission, which provides health care for many state employees, has moved to tighten the reins on out-of-network therapists. This has raised alarm among mental health advocates, who say stricter rules to gain approval for treatment aren’t just intrusive, but may violate federal rules aimed at bringing parity to medical and mental health care.
For now, the objections are premature.
The federal parity law recognizes the need to treat mental conditions that can be just as debilitating as bodily diseases. The measure prohibits health insurance plans from having more stringent reviews for treatment in a mental-health setting, such as hourlong talk therapy, compared to strictly medical treatments. But new regulations relevant to such reviews don’t take effect until July. Fortunately, there’s still time for the GIC, its various health plans, and other insurance providers to take a close look at their policies and make sure they are compliant with the law.
But at the heart of the GIC controversy is the broader question of how best to manage the mental health of patients in tough economic times. As employers and governments struggle to get a grip on spiraling health care costs, insurers will inevitably press medical providers harder on whether specific treatments for all manner of patients are necessary and effective.
In the GIC’s case, a 22 percent increase in mental health insurance rates prompted the commission to analyze its members’ usage patterns. It identified outpatient, out-of-network visits as an area where more careful monitoring was needed. That led to the new rule that out-of-network therapists for enrollees of the GIC’s largest insurer, United Behavioral Health, must justify — via a written form and sometimes phone calls — a patient’s need for treatment every 10 sessions.
Some therapists are complaining that the reviews are burdensome and the phone calls intimidating. The fear is that some therapists will drop their patients to avoid the hassle. That would be a sad outcome, but whether the practice is discriminatory is a much tougher question. Whether a patient needs additional weekly therapy sessions is necessarily a more complex issue than, say, whether a broken arm has healed.
United Behavioral Health says the average duration of a call to discuss treatment was eight minutes. The GIC says it recently implemented cost-containment measures for purely medical services, as well. For example, in November it voted to implement upfront deductibles for medical insurance plans that were not applied to mental health care coverage.
In an era of double-digit increases in health care premiums, psychotherapists aren’t the only health care providers who will face more stringent reviews. The trouble emerges when patient management tools become an excuse for insurers to game the system and lower costs at the expense of necessary treatment for patients. It would be wise for the GIC to stay vigilant and make sure it doesn’t fall into this trap.
