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Insurance Mergers Leave Patients Little Choice

     

Recently, insurance giant Anthem agreed to acquire Cigna in a deal worth up to $54 billion. In addition, Aetna and Humana also announced plans to merge. If approved, the mergers would consolidate four of the nation’s five largest insurers. We at APA strongly believe our patients would be severely impacted.

Our colleagues at the American Medical Association, the American Hospital Association and the American Academy of Family Physicians have all spoken out, and we share their concerns. These mega mergers would effectively eliminate consumer choice and encourage insurers to raise prices and reduce the quality of care in many regions of the country.

Patients with mental illness, including substance use disorders, would be uniquely affected by the consolidation because of its impact on access to psychiatric care in provider networks. Moreover, Anthem and other insurers have routinely flouted regulations put in place by the Mental Health Parity and Addiction Equity Act (MHPAEA) passed in 2008. Here’s what that unabashed discrimination against our patients has looked like:

Maintaining inaccurate and inadequate provider networks

While insurers are supposed to maintain accurate, up-to-date listings of physicians in their networks, in reality, many of those providers are not able to see patients who purchased coverage. Maintaining an inaccurate directory is a benefit to an insurance company because it allows it to advertise a “robust” directory that will then attract premium-paying customers. But of course the insurer is then able to avoid paying the costs associated with providing needed mental health care when the providers are not available.

Intentionally discouraging psychiatrists from providing care

Insurers work to discourage psychiatrists from participating in their networks by paying them less than other physicians receive for the same procedures. The logic is simple: if psychiatrists are discouraged from participating in a plan, patients do not access care and the insurers do not have to spend money on mental health services. APA has filed litigation against Anthem alleging that this practice violates the MHPAEA.

Artificially limiting services

Insurers deny mental health claims much more often than other medical claims. Artificially limiting care is a violation of the MHPAEA.

Diminishing the standard of psychiatric care

An issue of particular concern to psychiatrists is the adverse effect the imposition of strict medical necessity criteria and admission procedures by insurers could have on the quality of care physicians are able to give their patients. These guidelines and their payment models can decrease the effectiveness of care and the ability of patients to access it.

The proposed mergers would only embolden large insurance companies to continue in these and other discriminatory practices. That is why we have sent a letter to the U.S. Department of Justice voicing our concerns and urging them to thoroughly scrutinize these mergers, which we feel puts our patients at risk.

Mergers like this represent a real threat to consumer mental health and well-being, and we owe it to our patients to take a stand against them.


This post is co-authored by APA President Renée Binder, M.D. and APA CEO and Medical Director Saul M. Levin, M.D., M.P.A.


What APA is Doing for You

This blog post is part of an occasional series highlighting how APA advocates on your behalf to support the profession of psychiatry and put our interests before key policymakers.

     

Post by Saul Levin M.D., M.P.A.

Saul Levin, M.D., M.P.A., FRCP-E, is APA's CEO and Medical Director. Read Dr. Levin's full biography

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