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Changes will mean patients will only be covered for psychiatrists’ services that include medical evaluation and management; CPT coding will not allow for coverage of psychotherapy as a separate and equal category for payment.
The Mental Health Parity and Addiction Equity Act, the Connecticut Parity Law, Health Insurance Portability and Accountability Act, and the Unfair Insurance and Unfair Trade Practices laws are under threat due to the implementation of new Current Procedural Terminology (CPT) codes by Anthem Blue Cross Blue Shield of Connecticut.
According to the Connecticut Psychiatric Society, the American Psychiatric Association (APA), and the Connecticut State Medical Society, the CPT changes will mean patients will only be covered for psychiatrists’ services that include medical evaluation and management; the coding will not allow for coverage of psychotherapy as a separate and equal category for payment.
In a statement to the press,1 the APA noted, “This policy violates the spirit, intent, and the letter of federal and state legislation that was designed specifically to prohibit insurers from discriminating against mental health and substance abuse patients through non-quantitative treatment limitations such as inequitable rates for mental health physicians, and requires that mental health benefits be covered in a manner that is equal to benefits provided for medical/surgical issues.”
Jacqueline Coleman, Executive Director of the Connecticut Psychiatric Society, added, “We will not allow insurance companies to deny coverage that patients and their employers have paid for, nor will we ask psychiatrists to provide medically necessary psychotherapy for free to insured patients.”1
According to the Hartford Courant,2 Anthem has responded to these claims by noting Anthem was simply responding to the American Medical Association’s changes and updates to codes regarding behavioral health services. The Courant shared the following statement by Anthem spokesperson Sara Yeager: “In compliance with federal law, Anthem implemented the code changes and adopted new fees to match to the new codes. Anthem sought to preserve the level of payment that behavioral health providers were receiving before the code changes.”2
References1. APA Calls for Anthem to Stop Discriminating Against Mental Health Patients. APA Press Release. March 14, 2013. http://www.psychiatry.org/File%20Library/Advocacy%20and%20Newsroom/Press%20Releases/2013%20Releases/13-14-Anthem-Blue-Cross.pdf. Accessed March 18, 2013.
2. Sturdevant M. Anthem Responds To Criticism Over Psychotherapy Reimbursement. Hartford Courant. March 15, 2013. http://courantblogs.com/ct-insurance/anthem-responds-to-criticism-over-psychotherapy-reimbursement/. Accessed March 18, 2013.