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.

(image: Stuart Miles/Shutterstock.com)

APA Members Urged to Register CPT Coding Abuse by Insurers

APA is strongly encouraging its members to inform the Association of any problems of which they are aware stemming insurers' refusal to pay for services in accordance with the new psychiatry CPT codes that went into effect January 1. In an e-mail to members earlier this week, APA stated that "CPT code changes were intended to more accurately reflect the work psychiatrists do and improve patient access to care, but instead have been used as an excuse by some payors to discriminate against psychiatric patients and their psychiatrists in violation of the Mental Health Parity and Addiction Equity Act (2008). The issues differ from state to state and from carrier to carrier. The APA Board of Trustees has committed significant APA resources, both financial and staff, to understand the situation and use all reasonable means, including litigation, to correct the abuses taking place."

To ensure that insurers comply with the law, APA wants members' input as soon as possible so the Association can pursue action with the insurers in question, including filing of lawsuits to force compliance. "APA members must be willing to register their complaints with APA, and a few must be willing to participate as plaintiffs in a lawsuit if one is needed. This would require very little of your time and be at APA's expense," the message explained. Members can register complaints either by completing the form online here or by sending an e-mail to cptparityabuses@psych.org that includes the member's name, location, the insurance company in question, and details about the CPT coding problem. APA and its district branches/state associations have already begun actions against insurers in California, Connecticut, and New York.

Read about the changes to CPT psychiatry codes in Psychiatric News here and here.

(image: Stuart Miles/Shutterstock.com)