APA, Connecticut Psychiatrists Sue Insurer Over Parity Violations

APA, the Connecticut Psychiatric Society, the Connecticut Council of Child and Adolescent Psychiatry, and two individuals have filed suit against a major insurer charging that it has denied care and taken other actions that are violations of the federal mental health parity law. Their suit says that Anthem Health Plans and its parent company, Wellpoint Inc., have used Current Procedural Terminology (CPT) codes to reduce the fees they pay to the psychiatrists who provide care to the company's beneficiaries, thus forcing the patients to shoulder a larger financial and administrative burden than if they received care for a physical rather than mental illness. APA and the other plaintiffs maintain that these actions discriminate against psychiatric patients and are a violation of the Mental Health Parity and Addiction Equity Act (MHPAEA).

In laying out Anthem's alleged parity-act violations, the plaintiffs state that the company's CPT coding "manipulation" is discriminatory because it "preclude[es] psychiatric patients from receiving psychotherapy from a psychiatrist in the same session as the patient is medically evaluated, thereby increasing the time burden and imposing additional copayment obligations on mental health patients" and that by paying rates to psychiatrists for evaluation and management services that are 20% lower than what it pays other physicians, the company's roster of in-network providers is greatly diminished making it difficult for beneficiaries to access mental health care.

Commenting on the lawsuit's filing, APA President Dilip Jeste, M.D., emphasized that “APA worked hard to ensure passage of the MHPAEA so that mental health patients would not be deprived of treatment or stigmatized for seeking it. Anthem, Wellpoint companies, and others throughout the U.S. need to start respecting the law and our members’ patients and not directly or indirectly inhibit access to the treatment for which the patients and their employers have paid.”

In March, APA and the Connecticut Psychiatric Society wrote a letter to Anthem Blue Cross Blue Shield of Connecticut protesting the discriminatory practices and calling on the insurer to comply with both the federal and Connecticut parity laws. Read more about that in Psychiatric News here.

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