The mental health parity fight goes to the next level–the courts.

http://www.nytimes.com/2010/05/10/health/policy/10health.html?src=me

I’m not surprised by this latest move by the insurance companies.  I used to work for one, which will remain nameless.   They are probably protesting because they are used to using tight internal rules about “medical necessity” to try to control costs (and maintain a profit).  I predict that they will fight to the death to keep this practice growing, and that we will see more denials of mental health/substance abuse care on the basis of “medical necessity” coming down the pike as they try to maintain their profits and also keep costs down.

The following is taken from http://www.cms.gov/HealthInsReformforConsume/04_TheMentalHealthParityAct.asp and describes what the parity law says about “nonquantitative treatment limits”.

The regulation distinguishes between quantitative treatment limitations and non-quantitative treatment limitations. Quantitative treatment limitations are numerical such as visit limits and day limits. Nonquantitative treatment limitations include medical management, step therapy and pre-authorization. There is an illustrative list of nonquantitative treatment limitations in the regulation. A group health plan cannot impose a nonquantitative treatment limitation with respect to MH/SUD benefits in any classification unless, under the terms of the plan as written or in operation, any processes, strategies, evidentiary standard, or other factors used in applying the nonquantitative treatment limitations to MH/SUD benefits to MH/SUD in a classification are comparable to and applied no more stringently than what is applied to medical/surgical benefits except to the extent that recognized clinically appropriate standards of care may permit a difference.

I know this stuff can be confusing.  If you have any questions, feel free to comment and I’ll try to answer them.

About Nate Prentice, MSW, LCSW, CAS-PC

Nate Prentice, MSW, LCSW is a Licensed Clinical Social Worker and Pastoral Counselor who maintains a private psychotherapy practice in Drexel Hill, PA.
This entry was posted in Uncategorized and tagged , . Bookmark the permalink.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s