Mental health discrimination no easy fix [Fairfield County Business Journal]

Representatives of the American Psychiatric Association say the Connecticut Insurance Department should be doing more to stop discriminatory practices by mental health insurance plans.

Insurance Department Commissioner Thomas Leonardi announced in late April that the department had reviewed Anthem Health Plans Incas policies and that about 28,000 previously denied mental health claims would be reprocessed. which could amount to nearly $400,000 in reimbursements.

However APA CEO James Scully said the agreement does little to solve the underlying problem of discrimination. In a prepared statement, he called the deal a "back door attempt to achieve some positive press," amid the APA's lawsuit against Anthem and its parent company, WellPoint Inc. Anthem is headquartered in Wallingford.

Earlier in April, the APA, along with the Connecticut Psychiatric Society and the Connecticut Council on Child and Adolescent Psychiatry, filed a lawsuit against Anthem and WellPoint for allegedly violating the Mental Health Parity and Addiction Equity Act. The complainants contend the companies don't treat mental health claims the same as physical claims, leading to greater financial burdens and time constraints for patients.

"This is just a total press game - they cut this deal in the closet," said Colleen Coyle, general counsel for the APA. "This is a very important issue for our patients and it's just becoming exponentially more important now that states are setting up their insurance exchanges."

The Parity Act, passed in 2008, requires insurance companies to offer mental health benefits. It also prohibits terms or conditions that make it harder for individuals to receive mental health treatment in comparison with physical treatment.

In the APA complaint, Anthem and WellPoint are accused of refusing to cover psychoanalysis if a doctor has done a medical evaluation in the same appointment. As a result, either doctors aren't reimbursed for their work or patients have to schedule twice as many appointments, pay twice as many co-pays and take twice as much time off from work, the complaint states.

Anne Melissa Dowling, deputy commissioner of the state Insurance Department, said the department is spending a lot of time looking into Parity Act compliance. A number of new rules and code regulations related to the law have gone into effect over the last couple years and it takes time to build up the data to review compliance, Dowling said.

Additionally, the department is anticipating more changes this year based on legislation that could come about as a result of the Sandy Hook Advisory Commission's recommendations.

"This is one of the focus areas of the agency going forward," Dowling said. "A lot of it is working from the same understanding of what parity is, talking to all the carriers involved to make sure they're executing claims and paying providers appropriately."

When the issue of how Anthem processes mental health claims came to the department's attention, Dowling said they worked to immediately address it Though the APA says it should have been included during the department's review of Anthem, Dowling said it would have been inappropriate. The regulatory work the department does is not the same as a statewide effort to improve mental health coverage, Dowling said.

"We asked (Anthem) to correct what they could immediately and asked them to do what they can as they move to the new codes," Dowling said. "We're not dealing with (APA's) issues and with their lawsuit."

Maria Pepe VanDerLaan, a partner at Murtha Cullina L.L.P. and attorney for the APA, said the Insurance Department's agreement with Anthem was only a Band-Aid and that more work needed to be done to improve access to mental health care.

"Nobody in the mental health industry was aware of that deal and it is extremely disappointing if you are in an organization, or have made it your life calling, to protect the rights of mental health patients," VanDerLaan said. "They completely shut providers out of the discussion. You'd think if they were interested in having an intelligent conversation, my clients would have been invited to the table."

As far as the APA is concerned, the lawsuit is still in full swing.

"Historically in society, mental health is just something people didn't talk about and didn't want to deal with," VanDerLaan said. "Insurance companies have frankly treated it similarly. They treat it as if there is a stigma around it."