PSYCHOLOGISTS: Take Managed Care To The Courts
Psychologists frustrated with the "cost-driven effort by HMOs to push drugs over talk therapy, second-guess psychologists' decisions and dictate methods of treatment" are taking action. The Wall Street Journal reports that lawsuits are popping up around the country as psychologists pursue litigation in an effort to alleviate managed care pinch. Backed by the American Psychological Association, plaintiffs are employing "intriguing legal strategies" in the fight, charging defendants, including Aetna Inc.'s Aetna U.S. Healthcare, Blue Cross Blue Shield and Cigna Corp., with making "false promises to employers and patients."
Best Defense Is A Good Offense
The Virginia Academy of Clinical Psychologists yesterday filed suit against Blue Cross Blue Shield of the National Capital Area, alleging that the Blues CapitalCare HMO "trumpeted a generous mental health benefit of up to 20 therapy sessions a year," only to pressure therapists to "wrap up cases" in 10 sessions or less. Further, the plaintiffs charge that contractors for the HMO slashed therapists' fees by one-third and penalized those who acted as patient advocates. Similarly, the California Psychological Association filed suit in California in September, alleging that Aetna U.S. Healthcare and its two subcontractors, Adventist Health Behavioral Care and Magellan Behavioral Health, routinely engaged in false advertising by promising 20 to 50 sessions each year, but in practice limiting coverage to eight visits. The Journal reports that in the interest of cost, many managed care companies employ social workers, who provide counseling at a lower cost than psychologists. As a result, many HMOs are putting the squeeze on psychologists, and the New Jersey Psychological Association responded with a lawsuit two years ago. The group alleges that Cigna's MCC Behavioral Care "systematically purged its therapist ranks," noting that some therapists "were deemed 'not managed care compatible.'" While the therapists perceive that their incompatibility stemmed from patient advocacy, MCC "vigorously denies" the allegations (Lagnado/Jeffrey, 12/11).