Half a Mind

In a world where insurance companies treat Viagra as a right, mental health care still struggles for acceptance. And in Florida, the state’s largest health insurance company recently tossed mental health services into the half-off bin.

Jacksonville-based Blue Cross Blue Shield of Florida offloaded management of its mental health reimbursements to a BCBS subsidiary, New Directions, in July and August of this year, leaving the doctors to negotiate new contracts with the company. Those new contracts dramatically slashed reimbursement rates for psychologists, psychiatrists and addiction therapists — by as much as 54 percent in some cases.

The move, which could force doctors to stop seeing longtime patients, has drawn the ire of the Florida Psychological Association and the American Psychological Association Practice Organization, which say the change violates the Mental Health Parity and Addiction Equity Act of 2008. That bill, passed in that bygone bipartisan era by Senators Paul Wellstone (D-Minn.) and Pete Domenici (R-N.M.), and signed into law by Pres. George W. Bush, requires that health insurers provide the same aggregate benefits to a person seeking treatment for conditions like depression and bulimia as they would for someone with skin cancer or kidney disease. Copays for mental health care cannot be higher for those with mental illness, and insurers can place no limitations on the number of times a patient can see a doctor or check into the hospital, if there are not similar limits on non-mental health coverage.

According to the American Psychological Association Practice Organization, the recent halving of reimbursements for mental health care is cause for concern, and can be expected to cause “likely harm to mental health patients.” In an Oct. 5 letter to the secretaries of the U.S. Department of Labor, the Department of Health and Human Services and the Department of the Treasury, the APAPO asks that Blue Cross Blue Shield be required to “correct this parity violation” if it has not made similar cuts to medical/surgical services.

According to Connie Galietti, director of the Florida Psychological Association, the recent cuts are just one indicator of the devaluation of her profession. She says the stigma of mental illness keeps many patients from complaining about disparities in health care coverage, and she fears that where Blue Cross goes, other insurers will follow. But she emphasizes the concerns are not all about money. Patients see therapists and psychiatrists over the long term, which can be necessary for treatment to succeed.

“It’s different than going once a year for a physical,” she says in a telephone interview from her Tallahassee office. “When you see a mental health provider, you are establishing a relationship to help you deal with any difficulties in your life.”

If doctors and therapists decide to only take self-pay patients and abandon Blue Cross, that will leave a whole class of patients who can’t afford to pay out of pocket, possibly facing a dangerous cessation of treatment.

Asked about the reimbursement cutbacks, BCBS of Florida spokesperson Paul Kluding explained in an email that the change is being made “to be more consistent with market rates in the area.” He insisted it wasn’t a matter of health care parity, because other doctors in other specialties had their contract terms changed, too. He did not provide examples by our deadline.

The issue has gotten attention beyond Florida’s borders. The Washington, D.C.-based Parity Implementation Coalition, comprising 13 mental health and addiction treatment facilities including the Betty Ford Center, is appealing to CEOs of Blue Cross Blue Shield companies to rescind the decision. Jacksonville psychiatrist Dr. Michael Pruitt has been meeting with Blue Cross Blue Shield executives on behalf of the Florida Psychiatric Society for the same purpose. And the three federal agencies contacted by the APAPO have all agreed to investigate the matter and see if BCBS’ new policy violates parity laws.

Susan Cooper E

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