In Lawsuit, Psychiatrists Claim Anthem Discriminates Against Mental Illness
The American Psychiatric Association, the Connecticut Psychiatric Society, the Connecticut Council of Child and Adolescent Psychiatry, and two individuals filed a lawsuit Wednesday alleging that Anthem Health Plans discriminates against patients with mental illness.
The complaint, filed in federal court, says Anthem and its parent company, Wellpoint, used changes in billing codes as an excuse to reduce the fees paid to psychiatrists. The change in billing codes also increased the cost to patients at a greater rate than for other medical care.
It goes onto allege that Anthem is in violation of the 2008 Mental Health Parity and Addiction Equity Act — the federal law which sought to end discrimination against those with mental illness.
“APA worked hard to ensure passage of MHPAEA so that mental health patients would not be deprived of treatment or stigmatized for seeking it,” Dr. Dilip Jeste, president of the American Psychiatric Association, said in a press release. “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.”
Dr. Carolyn Drazinic, president-elect of the Connecticut Psychiatric Society, said insurance companies have had enough time to comply with the law.
“The time has come to enforce the Mental Health Parity and Addiction Equity Act. All patients should receive the same benefits for mental health services as for medical services, without discrimination,” Drazinic said.
The lawsuit says Anthem precluded psychiatric patients from receiving psychotherapy from a psychiatrist in the same session as the patient is medically evaluated. That increases the amount of time and the number of co-payments a patient would have pay for each visit, according to the lawsuit.
The lawsuit goes onto say it found the financial burden is 93 percent greater for patients who use and purchase out-of-network benefits. Also, there are fewer psychiatrists in networks because the rates offered are 20 percent lower than the rates paid to medical doctors for similar medical evaluation and management services.
In January, the association asked the state Insurance Department to get involved and request information from Anthem. According to the lawsuit, Anthem told the Insurance Department that the new fee schedule and billing codes were only “representative” and that if a psychiatrist wanted he/she could submit a bill for a code not on their fee schedule.
“This practice effectively requires preauthorization of psychotherapy for any patient seen by a psychiatrist where the patient’s plan does not otherwise require such preauthorization or alternatively, asks the psychiatrist to provide the service and then ‘roll the dice’ as to whether Anthem will pay. Either option results in impeding access to psychiatric care,” the lawsuit says.
In March, the American Psychiatric Association, Connecticut Psychiatric Association, and the Connecticut State Medical Society wrote to Anthem President David Fusco to explain that Anthem’s implementation of the codes violated “federal and state laws and that its failure to include appropriate psychiatric codes resulted in improper billing for services.”
According to the lawsuit, Fusco responded “by ignoring most of the facts and not providing the information requested. Instead, Mr. Fusco claimed that Anthem had loaded one missing code onto its system and that its reimbursement rates and manner of establishing them was otherwise fine.”
In a statement Thursday, Anthem acknowledged communication with the groups.
“Anthem Blue Cross and Blue Shield understands how critical access to mental health services is to the overall health of our members,” the company said in a statement. “We have not been served a complaint. However, we recently received a letter outlining concerns regarding behavior health fee schedule changes for psychiatrists. We have communicated in response to the letter that we will be making changes to our fee schedule.”
The American Psychiatric Association has 34,000 members and 750 of those are in Connecticut, where the issue of mental health treatment has been a hotly debated topic in recent months since the Sandy Hook School shooting.
Last week, the Connecticut General Assembly passed legislation that seeks to improve access for patients with mental illness or substance abuse problems.
The bill requires mental health and substance abuse services to be considered “urgent care” and also shortens the review time for service requests from 72 hours to 24 hours.
The legislation also requires:
—insurance companies to inform consumers that they have the right to appeal a denial of care;
—the Insurance Department to evaluate and report on compliance with mental health parity laws, and;
—the health professional reviewing an insurance claim to have similar qualifications to the medical professional prescribing it.