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Massachusetts mental health care debate: Do new rules defy federal laws?

Massachusetts insurance lawyer news: Health insurance companies adopted new rules for patients to receive mental health care. Many questioning legality.

05/17/2010 // West Palm Beach, FL, USA // Tara Monks // Tara Monks

Boston, MA – A health insurance company in Massachusetts has placed new limits on its coverage for mental health care, raising concerns that the limits may violate federal laws intended to make mental healthcare accessible, according to The Boston Globe.

The semi-state agency, Group Insurance Commission, now requires therapists to undergo lengthy and repeated phone interviews, discussing patients’ progress before further treatment will be approved. The Globe reported that patients and therapists told reporters the interviews are burdensome and intimidating, and have sometimes prompted patients to end treatments.

The Group Insurance Commission changed its rules for mental health care last year. The company now requires therapists who are not in the commission’s roster of approved specialized doctors to validate their treatments through lengthy interviews every 10 weeks. Previous to the change, therapists were only required to fax the insurer a progress report.

Executive Director of the Group Insurance Commission, Dolores Mitchell, told The Globe that the agency imposed the new sanctions because mental health insurance rates have jumped 22 percent in some areas over the past year. She stated, “I don’t think we’ll have savings with these changes, but I think we will put the brakes on increase.”

She further reported the commission is investigating whether its newly imposed regulations comply with federal regulations that require accessible mental health care from companies that provide it.

Many believe the restrictions may violate the 2008 federal mental health parity act, which requires employers that offer mental health coverage to provide the same level of service as they do for other aspects of healthcare. Under the law, a company’s plan may not limit the number of visits to a therapist without placing the same limitations on other doctors. Also, health insurance providers may not require employees to pay more for mental health sessions than other visits as well.

Last month, the mental health parity law increased its regulations, stating employers’ plans are not allowed to impose other limitations on mental health treatments that are not required for other medical services.

Legal advocates state the newest rule means insurers are not legally allowed to interrogate therapists about their patients’ progress unless the insurers require other specialists to do the same. For example, unless the company requires extensive reasoning from a doctor prescribing regular dialysis for patients with kidney failure, the firm is not allowed to grill therapists about further treatments.

Matt Selig, executive director of Health Law Advocates, a public interest law firm based in Boston, stated “We are seeing what seem to be excessive preauthorization and other reviews that we don’t typically see for other medical services.”

Therapists throughout the state claim the increase in authorizations required for patient treatments has resulted in their spending many more hours fighting with reviewers in order for patients to get the care they need.

Group Insurance Commission and many other Massachusetts companies use the California-based insurer United Behavioral Health for mental health services. The organization states that 12 percent of the states 1.2 million residents receive mental health treatment. The only state that has a higher percentage of residents who receive mental health care is Rhode Island.

Stephen Schlein, a psychologist from Lexington, reported that United Behavioral Health reviewers decided to cease coverage of mental health sessions for three of his patients in the last few months, including a suicidal 21-year-old college student and a 60-year-old man suffering from terminal cancer and depression.

Others are now refusing to accept new patients who use the insurance provider, due to what they felt was excessive bullying from interviewers during screening processes.

The National Association of Social Workers, Massachusetts, has asked for a meeting with United Behavioral Health to discuss the new rules.

Media Information:

Phone: 561-653-3266

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