APA Files Amended Complaint Against Anthem Health Plans: Unresolved Potentially Discriminatory Practices Risk Patient Harm

The American Psychiatric Association (APA), the Connecticut Psychiatric Society, and the Connecticut Council for Child and Adolescent Psychiatry filed an amended complaint Friday [September 20, 2013] in a lawsuit originally filed against Anthem Health Plans, Inc. and its parent company, Wellpoint, Inc. in April 2013. The amended complaint asks the Court to enforce federal and state laws designed to protect mental health patients against direct and indirect discrimination in the provision of health care benefits.

According to APA President Jeffrey Lieberman, MD, APA’s action comes after months of waiting to see whether the Connecticut Insurance Division alone or in combination with Anthem would end the discriminatory practices outlined in APA’s original complaint and ensure equal access to quality care for those seeking treatment for mental health or substance use disorders.  “Sadly, neither Anthem nor the Connecticut Insurance Division have made any effort to solve the problem,” said Lieberman.

APA alleges that Anthem Health Plans’ January 2013 and subsequent changes in its rate schedules for services provided by psychiatrists violate the Mental Health Parity and Addiction Equity Act (MHPAEA) and Connecticut parity law and restrict access to mental health care for patients in Connecticut. The actions by Anthem manipulate the rate reimbursed for psychiatrist-provided psychotherapy, imposing a greater burden upon mental health patients than for patients seeking other kinds of medical or surgical services.

“The actions taken by Anthem in Connecticut in manipulating the reimbursement rates for psychiatric services is an example of the kinds of barriers to care insurance providers unfairly impose on people with mental illness,” said Lieberman. “Insurance exchanges will soon be open under the Affordable Care Act and insurance plans should not be permitted to discriminate against mental illness. MHPAEA is a good law that needs to be enforced so that people in need of mental health care do not slip through the cracks. We can no longer tolerate discriminatory practices that impede access to care.”

The amended complaint alleges that Anthem’s discriminatory practices unfairly burden people with mental illness by discouraging receiving medical and psychotherapy services in one visit and instead setting up a system that would require patients to make two appointments, miss more time from work and make additional out of pocket payments. These barriers to care do not exist for other illnesses like cancer or diabetes. Anthem’s failure to pay psychiatric physicians in a manner comparable to other physicians performing similar services results in fewer psychiatrists willing to participate in a network and restricts patient access and choice.

“The APA continues to fight for equal rights for people with mental illness,” said Lieberman. “Our efforts in Connecticut are indicative of our vigilance for ensuring patients have access to a full continuum of psychiatric services.”

The American Psychiatric Association is a national medical specialty society whose physician members specialize in the diagnosis, treatment, prevention and research of mental illnesses, including substance use disorders. Visit the APA at www.psychiatry.org.

Speak Your Mind