HARTFORD, CT — U.S. Sen. Chris Murphy said insurance companies are circumventing the 1996 mental health parity law by erecting “bureaucratic hurdles” for patients who want to access the coverage that’s in their insurance plan.
Some of those hurdles include requiring a patient to fail first on certain drugs or requiring prior authorization for certain treatments.
Murphy said removing those hurdles is the most important part of the Mental Health Reform Act he’s been working on for two years. The legislation could come up for a vote in the U.S. Senate following the Nov. 8 election.
“Today, your health plan tells you, you have mental health insurance coverage, but you often run into so much red tape you can never access it,” Murphy said Monday at a Legislative Office Building press conference.
Murphy added: “Discrimination is still rampant in the healthcare system when it comes to treating people with mental illness.”
The Mental Health Reform Act, which is co-sponsored by eight Republicans and eight Democrats, includes a provision that would cure continued discrimination against people with a mental illness. He said the legislation provides clear guidance to insurance companies about what would put them in violation of the existing parity law.
“Insurance companies will tell you right now it is unclear which internal mechanism, like fail first policies, like prior authorization policies, are acceptable under the parity law and which aren’t,” Murphy said.
He said requiring pre-authorization for certain treatments or drugs would still be allowed under the legislation, but they can’t be more rigorous than procedures for the treatment of a physical condition.
The weakness of the current parity law is stopping millions of Americans from getting the care that they need, Murphy added.
Dr. Peter Jacoby, chairman of Saint Mary’s emergency department, said there’s a shortage of psychiatric beds at almost all hospitals and a lack of appropriate out-patient resources.
He said the shortage leaves patients stranded for hours and even days in the emergency department. He said one uninsured 13-year-old with autism was stuck in the emergency room for more than 20 days.
He said Saint Mary’s in Waterbury has 12 psychiatric beds for adults and they are always full. Often there are more patients than available beds, which means many are waiting for hours on stretchers in hallways.
The American College of Emergency Physicians recently released a survey of 1,716 emergency room physicians, which found three out of four see at least one patient — often more — every shift who requires hospitalization for mental illness. The same survey found that more than seven in 10 emergency physicians reported that on their last shift there were psychiatric patients in the ER waiting for beds.
But it’s not just a problem for emergency rooms.
Dr. Frank Fortunati, medical director at Yale New Haven Psychiatric Hospital, said there is not an adequate number of providers enrolled with insurance companies to serve the population.
“We routinely have trouble finding after-care for patients discharged from the psychiatric hospital,” Fortunati said.
He said if a cancer patient is discharged and chemotherapy is ordered, it’s easier for that patient to find chemotherapy services than it is for a patient with a mental health condition to find a provider.
Fortunati, a practicing child psychiatrist, said he’s had to spend 45 minutes to an hour on the phone with an insurance carrier in order to prescribe a stimulant medication to a patient with Attention Deficit Hyperactivity Disorder.
He said if he was visiting his primary care provider and needed blood pressure medication, “I’m quite certain that same authorization process does not occur.”
The Mental Health Reform Act also requires more audits of insurance carriers, Murphy said. It says that after more than five complaints the U.S. Department of Health and Human Services would have to audit an insurance carrier to check whether it is requiring longer conversations in order to allow a physician to prescribe a medication for depression versus a five-minute conversation for a heart and hypertension treatment.