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Holding Insurers Accountable for Parity in Coverage of Mental Health Treatment
Paul S Appelbaum1, Joseph Parks1
1Elizabeth K. Dollard Professor of Psychiatry, Medicine and Law, Department of Psychiatry, Columbia University, New York (Appelbaum); National Council for Behavioral Health, Columbia, Missouri (Parks). Paul S. Appelbaum, M.D., is editor of this column.
Abstract:
Despite a series of federal laws aimed at ensuring parity in insurance coverage of treatment for mental health and general health conditions, patients with mental disorders continue to face discrimination by insurers. This inequity is often due to overly restrictive utilization review criteria that fail to conform to accepted professional standards. A recent class action challenge to the practices of the largest U.S. health insurer may represent an important step forward in judicial enforcement of parity laws. Rejecting the insurer's guidelines for coverage determinations as inconsistent with usual practices, the court enunciated eight principles that defined accepted standards of care.
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