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

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 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.
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