A patient represented by an attorney obtained AETNA health insurance coverage for rTMS treatment of bipolar depression. The patient satisfied the insurer’s policy guidelines for rTMS treatment of major depression by demonstrating failed trials of 4 different medications. Reimbursement was based on the plan’s allowed percentage of the “covered amount”. The AETNA Appeals Decision stated: “TMS treatment is being authorized for …
Parity is What We Want
An overwhelming majority of Americans want parity. A large study found that almost 90% of Americans reported that mental health and non-mental health care were equally important to them in terms of their overall well-being. At the same time nearly a third of those Americans surveyed felt that mental health care was inaccessible and 40% felt that it was something that …
Parity Website
We ran across information about a new website that is drawing attention to the issue of mental health parity and that is dedicated to helping people get the behavioral health treatment they need – Paritytrack.org. The essence of the federal law that requires mental health parity in insurance coverage is not that mental health needs to have a certain level of …
Mental Health Problems and Physical Health
An incredibly well researched article in the journal JAMA Psychiatry summarized a body of research on the impact of mental health conditions on overall mortality in the world population and concluded that roughly 10% of all mortality was related to mental health problems. As I’ve recently been wrestling with problems helping people get access to treatment I thought it might …
Mental Health Parity Victory in California
On September 10th the California Supreme Court let stand a California Appeals Court decision that the California mental health parity law requires coverage of treatment that may have no equivalent in other medical specialties. Specifically, the Appeals Court held that Blue Shield of California must cover residential treatment for eating disorders. The Court noted that residential treatment was among the …
The Trap of Stress Disability
The other day I was asked to evaluate a fellow physician by his disability insurance company. When I do disability assessments I take particular care, because what I say has big implications for the person I am evaluating, and I try very hard to do an extremely careful and thorough job of assessing the person’s situation. Three quarters of the …
Parity Final Rules Issued
Mental Health Parity Final Rules were issued by the Obama Administration on November 9th, 2013. Here is a preliminary summary of the rules and their implications, based in large part on the analysis of the American Psychiatric Association’s Government Affairs Department. We were also lucky enough to have an experienced attorney with a lot of knowledge of health care law …
Fair Health
As the result of a bike accident last year we had a chance to experience first hand the crazy world of medical billing and reimbursement. Since then we have been following with greater attention the series of articles in the New York Times that try to explain why things cost so much in this country. A good friend recently suggested …
Mental Health Coverage Lawsuit
Meiram Bendat, a marriage and family therapist licensed by the California Board of Behavioral Sciences and a licensed attorney by the State Bar of California, has been making great strides towards helping people get insurance companies to cover treatment costs. In the past, his business Psych Appeal has aided both health care providers and patients in obtaining insurance reimbursement for medical …
Politics: How to Promote Mental Health in Government
I am back in Washington, DC for American Psychiatric Association governance meetings, and it is hard not to be thinking about politics in this incredibly political town. Ordinarily politics is a topic to avoid in a site like this one, but I am moved to ask you to help with one important and (relatively) non-partisan task – Join the entire …