Parity Pitfalls: Got depression? Separate Deductibles are Good For You! Really!
In the words of the inimitable Gomer Pyle, “Surprise. Surprise. Surprise.”
A group of three managed behavioral healthcare organizations, who suspiciously call themselves the “Coalition for Parity,” have sued the feds, claiming they were “denied their right to participate in the rule-making process” for implementation the Wellstone-Domenici Mental Health Parity and Addiction Equity Act.
Who didn’t see THIS coming?
The Coalition says the “interim final rule” drafted by the feds is so “vague,” “ill-informed,” “ill considered,” “fatally ambiguous,” “unrealistic,” “severely flawed,” “carelessly drafted” and “boundless” that the rule “does not advance the cause of mental health parity; but rather impedes it.”
According to court papers filed on April Fools Day (Seriously, they filed this on April 1) the Coalition for Parity says it “strongly supports mental health parity.” In fact, the Coalition is so concerned about parity that it believes separate deductibles are the best way to ensure that people like me, with mental illnesses, get the care we need – especially low-paid workers, addicts and alcoholics.
The Coalition predicts that all of our deductibles will go up if medical and mental health claims are lumped together. Right now “many” group health plans have separate, lower deductibles for mental health coverage, according to the Coalition (which conveniently failed to mention the lower level of care that comes with lower, separate deductibles). But when there is only one deductible, folks who are “medically” healthy but need mental health care are going to have to pay higher premiums than they would if they had a separate, lower deductible for mental health care alone.
Among the Coalition’s other fears: “The elimination of pre-authorization requirements will adversely affect the most vulnerable mental health patients because the tools employed to monitor their treatment will be gone” (Last fall – as parity neared – the American Psychiatric Association sent a letter to its members warning of the new, “onerous” pre-authorization and continuing care paperwork required by Blue Cross Blue Shield of Florida. The director of political affairs for the American Psychological Association called the new paperwork requirements “tourniquet gate-keeping.” Blue Cross agreed to modify the requirements.).
These, and the Coalition’s other dire predictions, are outlined its request for a rule-making do-over and a temporary restraining order barring full compliance on July 1. After an emergency hearing on April Fools Day, the judge denied the Coalition’s request, finding that there was no emergency because the interim final rule would not be enforced until July 1.
So, who is this Coalition for Parity that claims to contract with over 125,000 mental health providers and handles the mental health claims for insurance companies that cover over 45 million Americans?
Well, two of its members are ValueOption and Magellan Health Services. Both companies have been the targets of lawsuits and news reports of wrongful denial of claims. Magellan, which manages claims for many Blue Cross Blue Shield plans, was sued earlier this year for allegedly requiring practitioners to turn over confidential patient information before getting paid.
The Coalition’s lawsuit is about stigma. The members of the Coalition exist only because of the DISparity between mental and physical healthcare coverage. The Coalition’s arguments are based on the belief that mental and physical illnesses should not be treated the same. The Coalition will spend vast amounts of money to keep it this way.
What happens now? I don’t know. I worry because the lawmakers that fought tirelessly for over a decade to achieve parity are gone. Sen. Ted Kennedy is dead. His son, Rep. Patrick Kennedy, will not run again. Senator Jim Ramstad of Minnesota has retired.
Who will fight the battle?
Stapleton, C. (2010). Parity Pitfalls: Got depression? Separate Deductibles are Good For You! Really!. Psych Central. Retrieved on December 15, 2017, from https://blogs.psychcentral.com/depression/2010/04/parity-pitfalls-got-depression-separate-deductibles-are-good-for-you-really/