Wednesday, April 24, 2013

Insurer Says It Will Change Mental Health Fee Schedule After APA Files Suit

Today, the Insurance Commission of Connecticut issued a press release stating that Anthem had agreed to adjust its fee schedule for mental health care providers to recognize coding changes in Current Procedural Terminology (CPT). The readjustment, which will be retroactive to January 1, 2013, is reported to cover 28,000 claims and $400,000 in payments owed.

APA had initiated a lawsuit against Anthem and Wellpoint alleging that its implementation of the CPT codes violated the Mental Health Parity and Addiction Equity Act (MHPAEA) and state parity, contract, and consumer protection laws. According to APA Medical Director and CEO James H. Scully Jr., M.D., “APA cannot assume that Anthem’s proposed solution complies with federal parity law or that Anthem has ended its discrimination against those in need of mental health care and benefits that we alleged in our complaint.  In our view, the press release is interesting in that there is much that it does not say; leaving many outstanding issues that need to be resolved before we can assure members and their patients that Anthem is not discriminating against mental health patients. I have asked David Fusco, Anthem’s CEO, to provide answers to outstanding questions that appear not to have been addressed in this agreement with the Insurance Commission, which we understand was reached without consideration of the federal [parity] law."

In his communication with Fusco, Scully has requested that Fusco provide additional information about the plans to correct the MHPAEA violations alleged in APA’s complaint. APA says that "Whether Anthem and Wellpoint companies will continue their alleged violations of the MHPAEA and discrimination against mental health patients is unclear."

Read more about APA's suit against Wellpoint and Anthem in Psychiatric News.


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