Copyright 1999 The Washington Post
The Washington
Post
November 12, 1999, Friday, Final Edition
SECTION: FINANCIAL; Pg. E10
LENGTH: 444 words
HEADLINE:
HMO Doctors' Choice Has Limits; UnitedHealth Says Oversight Still Applies to
Mental Health
BYLINE: David S. Hilzenrath, Washington
Post Staff Writer
BODY:
UnitedHealth Group's announcement that it will let treating
physicians rather than managed-care overseers decide what care patients need
does not apply to mental health services, a United executive said yesterday.
That exception, which United had not publicized, came as an unwelcome
surprise to patients and mental health professionals, who learned of it through
their own interactions with the company.
United, one of the nation's
largest managed-care companies, shook the industry to its foundations this week
and won praise from doctors and other adversaries when it announced that it
would no longer require doctors to get United's permission before proceeding
with covered services. United said it was abandoning one of managed care's key
cost-saving techniques because it cost more than it saved and caused frustration
for doctors and patients alike.
But yesterday Saul Feldman, chief
executive of United Behavioral Health, the company's mental health subsidiary,
said patients and practitioners still need to get United's authorization before
beginning treatments such as outpatient therapy or psychiatric hospitalization
if United is to pay for the care.
"At this point more research is
necessary, though the literature in general suggests that the costs would
increase substantially" if United let mental health practitioners have the final
say, Feldman said.
"There is in medical care much more evidence-based
practice," while in mental health "you have a wide variety of treatment
philosophies and methods, the great majority of which have not been evaluated in
terms of efficacy," Feldman said. "While we've made a lot of progress" in
determining which mental health practices are best, "we're still far behind
medical care and we have a lot of catching up to do."
Advocates for the
mentally ill, who have been fighting for "parity" in behavioral health benefits,
criticized United's position as discriminatory.
"I guess they think
their accountants are going to be better at psychiatry than they are at the rest
of medicine," said Laurie Flynn, executive director of the National Alliance for
the Mentally Ill.
"We've had situations where people are very ill, even
suicidal, and they can't immediately be admitted to the hospital because they
can't get pre-certification," Flynn said, speaking generally of the industry's
practice.
Flynn said her organization would examine whether laws passed
in many states mandating parity between mental health coverage
and medical coverage prohibit United's double standard for
pre-certification.
The United employees reviewing the care are trained
clinicians, Feldman said.
LOAD-DATE: November
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