APA Practice Organization’s parity violations survey closing soon
By Legal & Regulatory Affairs staff
APA Practice Organization is considering collaborating with a state psychological association on class action litigation addressing violations of the federal mental health parity laws. The litigation would include patients and/or psychologists representing the interest of their patients as individual plaintiffs and proposed class representatives.
As part of that ongoing effort, APAPO is reviewing responses to the parity survey released in May 2013 to identify the companies that are involved with improper denials of care, to identify particularly egregious problems that patients are having and to identify potential plaintiffs.
Accordingly, if you have not responded to the survey but one of your patients has suffered a significant “denial” of mental health care as described below, please respond to the survey and provide your contact information so that we can learn more about significant problems. We are particularly concerned about company denials of care that significantly harmed patients or their care, for example by terminating or stepping down care too early.
If one of your patients has suffered a significant denial that you think may be relevant to our litigation assessment, and you responded to the survey before without providing contact information, we ask that you take the brief survey again and make it possible for us to contact you. Because the survey asks only for summary information, it is important for us to be able to follow up regarding denials that appear to violate the parity act.
The types of “denial” we are talking about are instances where:
- an insurance or managed care company denied your patient coverage for treatment or testing/assessment (hereafter we will refer to all of these services as “treatment”);
- a company denied treatment at the level and frequency that you recommended;
- the treatment you recommended was in your professional opinion medically necessary and appropriate;
- your patient’s plan and treatment was covered by federal (MHPAEA) and/or state parity law (If you are not sure, please go ahead and provide your information); and
- you or your patient appealed the denial to the company and were fully/partially unsuccessful, or there is still time to appeal and you/your patient intend to appeal.