Some Firms Enforcing New Limits on Mental Health Care Coverage
Increasing medical costs have prompted some employers to enforce new limits on coverage for mental health care, raising concerns that such limits violate federal regulations, the Boston Globe reports.
Some companies have begun requiring therapists to participate in lengthy and repeated telephone interviews about patients' progress before insurers will approve further treatment. Advocates of the limits have said they are attempting to ensure that health plans cover only treatment that is medically necessary.
Concerns Over Parity
However, patients and therapists say the additional oversight is troublesome and intimidating. They also say further restrictions sometimes lead to shortened treatment and prolonged appeals.
Mental health advocates have said the restrictions violate the 2008 mental health parity law, which mandates that most employers offer the same level of coverage for mental health care as other medical care.
According to the law, a company's health plan cannot limit the number of therapy visits for patients without placing similar restrictions on other physician visits and also cannot require that employers charge more for mental health sessions than for other medical sessions.
Legal Experts Weigh In
Legal experts have said that additional federal regulations do not allow insurers to question therapists about patient progress unless insurers question other medical specialists.
Matt Selig, executive director of Health Law Advocates, said, "We are seeing what seem to be excessive preauthorization and other reviews that we don't typically see for other medical services." Selig said HLA is gathering examples of such restrictions to determine whether a lawsuit is warranted (Lazar, Boston Globe, 5/17).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.