Friday, November 12, 1999
HMO keeps last say on therapy
New UnitedHealth policy has loophole
The Associated Press
NEW YORK — United-Health Group's new policy of letting doctors have the final say on patient care doesn't include mental health coverage, to the chagrin of therapists.
Mental health professionals for years have protested managed care's stringent restrictions on them.
UnitedHealth officials defend the exclusion, noting they have yet to study how their widely praised new policy would affect people seeking counseling or psychiatric care.
The nation's second-largest managed care company fears that costs would escalate if they loosened the reins on mental health providers because few objective tests exist to determine what type of care, if any, is needed.
“Mental health holds a lot more intangibles than medical care in determining what treatment someone needs,” said Saul Feldman, chief executive officer of United Behavioral Health, UnitedHealth's subsidiary that manages mental health and substance abuse benefits for 17 million Americans.
In the Tristate, United covers more than 80,000 people.
New parity laws
Under UnitedHealth's new policy, announced earlier this week, it will still closely monitor its physicians and require doctors to alert the health plan when they order expensive tests or admit patients to the hospital. But if there are disagreements on how patients should be treated, the doctor has the final say.
Mr. Feldman said new “parity laws” passed in 27 states that require health plans to offer equal coverage for physical ailments as for mental health benefits will push costs higher unless the company can tightly manage the care.
That task would be made more difficult if the health plan transferred final authority on patient decisions to therapists, he said.
“The issue we all have to recognize is there are legitimate differences between mental health care and medical care,” said Mr. Feldman, a psychologist.
The "poor stepchild'
Baloney, say mental health advocates.
“Mental health is always the poor stepchild, and this is more evidence of that,” said Russell Holstein, a Long Beach, N.J., psychologist.
UnitedHealth's decision was disappointing but not surprising, said Karen Shore, president of the National Coalition of Mental Health Professionals and Consumers in Commack, N.Y.
“There is a conscious or unconscious mean-spirited bias against mental health which the people in charge (of managed care firms) do not understand,” Ms. Shore said.
UnitedHealth's new policy excludes substance-abuse providers: Managed care firms usually combine oversight of mental health and substance abuse because treatments are closely linked.
United's changes come just as health care reform issues boil into a front-burner political issue in Congress and in the 2000 presidential campaign.
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