Therapy in L.A.


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June 2000
By Alan M. Solomon, Ph.D.

May 19, 2000

A public opinion survey of 800 California voters revealed that 79% believe that insurance companies should provide mental health coverage equal to coverage for physical illness. More than two thirds (69% actually) said that they wanted the full parity option. Full parity would cover all diagnoses where treatment was medically necessary.

Electoral support for full parity for mental health benefits included almost all demographic, political, partisan, and ideological groups. For example, Hispanics (65%), professional women (70%), and "Soccer Moms" (74%) support full parity. Of all registered Republicans, 58% support this kind of plan, while 52% of self-identified conservative Republicans agree.

An accounting analysis by Price-Waterhouse Coopers concluded that full parity would increase health insurance premiums by 94 cents per month. Limited parity would increase premiums by 85 cents. Very little added expense is needed for full coverage - only nine cents. This poll was sponsored by the California Psychological Association in August 1999.

Therapy Does Help Children and Adolescents - But Not in Tiny Amounts

More than eight therapy sessions produced "real improvement" for children and adolescents, according to a two-year study at Duke University Medical Center. Children who received only one or two therapy sessions actually worsened, compared to children receiving no treatment at all. Thus, parents should consider a commitment to therapy to be at least a few months' worth of appointments for benefits to accrue.

This study was led by Dr. Adrian Angold. It was published in the Journal of American Academy of Child and Adolescent Psychiatry in February 2000.

Authorization Necessary for Insurance Companies to Review Records

A medical doctor in Florida refused to release patient records for insurance review without a signed release form for each patient. The insurance company, Humana, argued that the doctor's contract stipulated that the records were the property of the company, so that a specific release was unnecessary. An appeals court in Florida disagreed, stating that a signed release form from each patient was required to release the records. The insurance company may appeal to the state supreme court.

This re-asserts the basic notion that a patient owns and controls the information contained in his treatment records. Neither the professional caregiver, nor the insurance company, can make any decisions about these records without the patient's explicit permission. Patients should be sure this is clearly understood with every caregiver they see for help.

Financial Incentives for Managed Care to Deny Treatment

Ever wonder why insurance companies deny treatment/reimbursement only to later allow it when you, or the doctor, more aggressively pursue it? One clear reason is likely to be the profits the insurance company can generate with delays.

A large accounting firm, Price Waterhouse Coopers, analyzed a recent version of the Patient's Bill of Rights under consideration in Washington, D.C. They found that if the insurance industry denied only one percent of claims and then reversed the denial following an independent review process, they could create $280 million in profit. The review process would allow the insurance company to invest the funds held up for a maximum of 377 days, which would generate huge additional gains.

Thus, legal accountability (read: lawsuits or the threat of a lawsuit) is needed to be sure the insurance companies have an incentive to not delay treatment, or deny treatment. Without this kind of legal pressure, the insurance industry has powerful financial incentives to deny care and then wait for an independent review to overturn the denial later, during which time they can greatly increase their profits while the patient suffers.

This analysis was sponsored by the American Psychological Association in the summer of 1999.

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