The San Diego Union-Tribune
May 22, 2002
By Rodrigo Munoz, a psychiatrist and president of the San Diego County Medical Society
… San Diegans will continue to be on the short end of the stick when it comes to accessing critical mental health services. That is because of the little-known but powerfully disruptive practice called a “carve-out,” which allows insurers to skirt around the laws on mental health parity and deliver the least amount of care for the greatest financial return.
On paper, carve-outs are simple to understand. Insurance industry giant XYZ Health is given the contract to insure the employees of a large corporation, probably by tendering the lowest premium bid. XYZ Health promptly subcontracts with a for-profit company to handle the mental health claims under the insurance policy, severing the mental health benefit from the rest of the policy, usually for as little as 25 cents per member, per month.
If you ask how any company could turn a profit when it is being reimbursed a quarter a month for each member of the insurance plan that might seek treatment, you’re onto something. The only way that these firms (called “behavioral health companies” in industry jargon) can make money is by making it virtually impossible for those in need to get treatment.
These companies make it hard for people to see a psychiatrist in the first place, limit the number of times a patient can see a psychiatrist, limit the amount of time they will pay for the psychiatrist to see the patient to 20 minutes and force people out of the hospital before they can safely go home, with no adequate follow-up provided. This is a clear violation of the mental health parity law, but they get away with it, because the benefit has been “carved out.”
The saddest thing is that many patients and even the employers who pay the bill don’t realize that the HMO they have entrusted with their business and their health has washed its hands of a piece of it. They only find out that XZY Health is out of the picture when they go to access treatment, unsuccessfully.
Treatment for disorders of the brain should not be carved out and away from the insurance benefit any more than diseases of the kidneys, eyes or heart. “Separate but equal” is no more tolerable in health care than it was in public education. Unless we end the practice, we will have to substitute the word “parody” for “parity” when discussing mental health treatment in San Diego.