Fighting Against the Arbitrary and Illegal Denial of Care
Associate Medical Director and Director of Biopsychosocial Advocacy Eric Plakun, MD, responds to the recent Times Union report that outlines BlueShield’s illegal denial of claims for mental and nutritional counseling:
The Mental Health Parity and Addiction Equity Act of 2008 (or mental health parity law) requires that mental health treatment be provided on a par with medical and surgical care—without quantitative limits (e.g., restriction on numbers of sessions) or non-quantitative limits (e.g., higher prior authorization burdens) for mental health care that are not comparable to those imposed for medical care.
Now that the mental health parity law's "final rules," which strengthen “access to mental health and substance use disorder benefits for low-income Americans” have been written, around the nation, attention is being drawn to the longstanding gap between the practices of many insurance companies and what the 2008 parity law requires – that treatment of mental health and substance use disorders be funded on par with medical and surgical conditions.
New York State Attorney General Eric Schneiderman is a leader in holding insurance companies accountable for arbitrary, illogical, and now actually illegal denials of needed and effective care. The same process is occurring in several other states, where class action lawsuits are unfolding that address insurance practices alleged to be unfair and in violation of both common sense treatment and the parity law.
Psychiatric treatment, including psychosocial treatments like psychotherapy, are effective. When combined, medications and therapy are better than either alone. Arbitrarily limiting the number of mental health treatment sessions per year (when we would never do the same for a person with diabetes, for example) violates the parity law and is based on bias against those with mental illness.
More resources and reading on mental health parity:
- What if the appeal comes from, rather than goes to, the insurance company? (a thread from Meaning Matters with commentary by Jay Einhorn, PhD; Eric Plakun, MD; Bob Fancher, PhD; Andrew B. Klafter, MD; and Jerry Fromm, PhD)
- What Does Parity Mean for Insurance and Residential Treatment for Mental Illness?
- Correcting Psychiatry's False Assumptions and Implementing Parity
- An Informed Response to the 60 Minutes Program, "Denied"
- Advocating for a Biopsychosocial Approach to Care
- Expert on Mental Health Parity Law Coming to Riggs