THIS STORY HAS BEEN FORMATTED FOR EASY PRINTING

Mental health providers’ alarm at insurers’ tactics is not premature

June 4, 2010

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REGARDING YOUR May 24 editorial “Protect mental-health parity, but scrutiny is inevitable’’: Contrary to what you wrote, “objections’’ and “alarm among mental health advocates’’ about tightened insurance reins are not premature.

My own experience with United Behavioral Health, and that of many colleagues, has made it clear that “patient management tools’’ have indeed become “an excuse for insurers to game the system and lower costs at the expense of necessary treatment for patients.’’ When the bottom line for insurers is profit, isn’t it naive to expect the Group Insurance Commission or any other insurance company to “stay vigilant’’ so as not to “fall into this trap’’?

Further, it is not true that the GIC is targeting only out-of-network providers in making more stringent demands to prove medical necessity. Since last autumn many of us who are in-plan providers have experienced this. UBH says its average clinical phone review is only eight minutes. That has not been our experience.

Getting only eight more visits for a patient in acute suicidal crisis required 90 minutes of preparation for nearly an hour on the phone, not to mention the inordinate invasion of my patient’s privacy.

Physical medicine would not tolerate this for patients with renal failure, but we see many patients with emotional problems that are just as chronic and life threatening.

Nancy C. Blackmun
Framingham
The writer is a psychologist in private practice.

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