Parity Laws: Powerful Weapon-or Pipe Dream?

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.”¹

Meanwhile, the New York State Psychiatric Association filed a class-action suit against UnitedHealth Group for violating both federal and state antidiscrimination laws.² 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. 

And just last month, the Connecticut Psychiatric Society, the American Psychiatric Association, and the Connecticut Council of Child and Adolescent Psychiatry along with two individuals filed a lawsuit  alleging Anthem Blue Cross and Blue Shield of Connecticut’s new Current Procedural Terminology (CPT) codes violated the MHPAEA and discriminated against patients with mental illness.³

Fortunately, in this last instance, the Insurance Commission of Connecticut stepped in, and now Anthem has agreed to adjust its fee schedule for mental health providers. Moreover, Anthem will begin reprocessing approximately 28,000 claims retroactively to January 1, 2013, which should result in approximately $400,000 in reimbursements.⁴

And so the war for parity wages on-now in the courtrooms--with endless battles quietly fought in daily clinical practice.

What are your experiences? Did the MHPAEA have any real impact on your ability to provide care to patients, or are you experiencing the shells and mortars of paperwork and denials? And will the average patient ever really benefit from the laws, or were they just passed to make the country feel better about the state of psychiatric care in the US?

References
1. United States District Court for the District of Vermont.  Case 5:12-cv-00108-cr.  Filed April 30, 2013.
2. Brauser D. NYSPA Fires First Legal Salvo Over Mental Health Parity Law. Medscape News.  April 9, 2013. 
3. Press Statement. American Psychiatric Association and Others Seek Court’s Intervention in Compelling Anthem and Wellpoint to End Alleged Discrimination Against Mental Health Patients. April 11, 2013.
4. Press Statement. Connecticut Insurance Department.  Insurance Commissioner: Anthem To Readjust Claims For Behavioral Health Providers. April 24, 2013.