Vermont Blues rations metal health services, APA says

Blue Cross Blue Shield of Vermont is violating a federal mental health parity law by rationing mental health services for its members, the American Psychiatric Association and the Vermont Psychiatric Association say. In a letter to the insurer, the groups said Blue Cross requires pre-authorization for mental healthcare after 10 visits, which violates federal law and a similar Vermont law, reported the Burlington Free Press. David Fassler, APA treasurer and clinical professor of psychiatry at the University of Vermont, said insurers are required to pay for mental illnesses and substance abuse treatment the same as any physical injury or illness. But Kevin Goddard, Blue Cross vice president for external affairs and sales, challenged the APA's claim. Since only a small proportion of members need more than 10 visits, Blue Cross implemented its pre-authorization requirement for subsequent care to ensure the treatment is appropriate and purposeful. "It is a care management tool," Goddard said. "We use care management tools across all types of care," including requiring prior authorization for MRIs to determine if the test is a medical necessity. Article

Suggested Articles

Healthcare leaders say the pandemic could prove to be the tipping point for digital health tools that can help manage patients outside hospitals.

As a health plan built on tech, Oscar Health was uniquely positioned to respond to the COVID-19 pandemic. 

FCC Chairman Ajit Pai wants to use $200 million from the economic stimulus package to expand telehealth services across the country.