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Wednesday, May 15, 2013

Parity Laws: Powerful Weapon--or Pipe Dream?

By Heidi Anne Duerr, MPH
Psychiatric Times
Originally published May 6, 2013

Is true mental health parity really possible, even with the Mental Health Parity and Addiction Equity Act (MHPAEA)? It’s beginning to look like the answer is maybe–but only with a fight.

Across the US, the war for parity is being fought, with numerous law suits asking courts to help ensure the law has real bite. In the meantime, does this mean patients without legal support and know-how are going without proper care—or that real parity is just a pipe dream?

Just recently, the US District Court for the District of Vermont was the first court to interpret and support the MHPAEA.1 In this case, the plaintiff alleged Fletcher Allen Health Care Inc, the plaintiff’s health plan administrator, violated the parity law “by imposing, both in writing and in practice, more stringent reviews for mental health benefits than are imposed for medical benefits.”

Specifically, the complaint noted the insurer “conducts prospective and concurrent medical necessity reviews of routine, outpatient, out-of-network mental health office visits while … [the plan] conducts no such reviews for comparable medical office visits.” In addition, the plaintiff alleged that the plan “imposes a numeric cap on the number of routine outpatient visits participants may request before pre-approval is required for all subsequent medical necessity reviews.”

Meanwhile, the New York State Psychiatric Association filed a class-action suit against UnitedHealth Group for violating both federal and state antidiscrimination laws. Among other complaints, the suit noted UnitedHealth Group denied or delayed access to care and required continuing authorizations for psychotherapy, intensive outpatient treatment, and partial hospitalization.

The entire story is here.