Managed Care

Mental Health Parity Just Around the Corner?

John Marcille

Don’t believe it until you see it. Our cover story on mental health parity by Contributing Editor Martin Sipkoff reports that we are at a turning point. The focus is mainly on what legislators will do, but Washington, D.C., is famous for good ideas that never became law.

As Martin notes, there’s a House version that practically no one likes and a Senate version that almost everyone likes. He artfully outlines the pros and cons of each and shows just what employers specifically, and the nation’s health care apparatus generally, would gain in outcomes and savings. He notes that although pharmacy costs did actually go up, “Aetna Behavioral Health demonstrated a total cost savings of $136 per member per month… compared to members who were not enrolled.” This experience and other data show that health plans should welcome the push for parity.

Now, on the matter of the New York attorney general’s attack on plans’ reimbursement of UCR charges. This is not the problem it is made out to be. Health plans just need to restate the formula as a percentage of what the plan pays to an in-network physician or other provider for that service, not tying it to an arbitrary UCR calculation. The plan should always pay outsiders less than it pays network providers, and that difference should be made clear. Why continue a system that is confusing and seems unfair?

Payers should have no trouble with this. Moreover, full transparency here will alert patients to exactly how much the non-network provider is charging. They can easily see why a network provider, in most cases as good as or better than the out-of-network provider, is to be preferred. They can also see that some providers are gouging the patient who has no health plan to negotiate prices for him and the patient who forgoes that advantage by going out of network.

Plans would have been better off, and will be better off, with real transparency.

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