LETTERS - Brief Article

0 Comments | Family Practice News, June 1, 2001

The Illusion of Parity

The article 'Advocates Seek Broader Mental Health Parity" prominently listed Minnesota as one of the few states with comprehensive parity between mental health services and care for other health problems (March 15, 2001, p. 37).

Despite that parity, the following chain of events just occurred.

The mother of a 17-year-old contacted me about several health concerns that she had about her son relating to weight changes, fatigue, irritability, and generally being "ill." She was able to convince him to see me, and it was clear that he was depressed.

I started him on a selective serotonin reuptake inhibitor, and his mother reported 2 weeks later that she was ecstatic at how he had improved.

She contacted me a week later, however, to apologize for the fact that her insurance had refused to cover the office visit. As it turns out, his policy requires him to go elsewhere for any mental health problems.

Even though mental health parity laws exist, insurers can still make it difficult or impossible for patients to obtain needed services by carving out a segment of care and assigning it to a facility that is inaccessible because of distance or a lack of appointments.

The mother was amazed at the stupidity of the insurance rules and wanted to pay for the office visit herself. I had to tell her that the physician was presumed by the insurer to have known that this was a carved-out service and therefore I could not accept her payment.

In the end, it is ironic that I did not get paid, even though I was astute enough to diagnosis his depression and treat his symptoms in a 15-minute office visit.

If I had ignored the possibility of depression, I would have had to aggressively pursue his diagnosis with laboratory tests, etc., at great expense to the insurer until I had ruled out any other serious problems that could have caused his fatigue and weight loss.

The worst part is that all of this could have been avoided if I had used creative coding and billed this patient's care as a case of fatigue and weight loss, rather than depression. Would that have been a moral thing to do?

Robert H. Bosl, M.D.

Starbuck, Minn.