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 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 …
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 …
Make Good on Parity
Today marks the 5th anniversary of the mental health parity bill which was to have ensured access to mental health services for all Americans with health insurance. Remarkably, the Obama administration has yet to issue the final regulations that will define how parity is implemented. In a very thoughtful piece published today in “The Hill” (a blog for lawmakers), former Representative …
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 …
Parody No More: Mental Health Parity Law
In yesterday’s clinical team meeting we were talking about the mental health parity law, which has been largely ineffective at ensuring access to care. One of the psychologists said, “I call it the mental health parody act,” because it is a parody of meaningful change. That may be changing. President Obama announced that the Sandy Hook school killings had galvanized …
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 …