Friday, July 02, 2010

NC State Teachers and Employees Will Have No Mental Health Parity

"Letter: Private-pay psychotherapy works

Friday, July 2, 2010

The North Carolina State Health Plan for teachers and state employees has recently announced that it has opted out of parity for mental health treatment. It is truly unfortunate that mental illness is not treated by the insurance industry with the same care or respect as physical illness.

But we may take this opportunity to recall that psychotherapy has not always been about mental illness. There have historically been and continue today to be many forms of psychotherapeutic treatment that target much more broadly defined goals, such as “feeling better.” Research has repeatedly found that psychotherapy can help increase well being and enhance social functioning....."

This is my comment to the article:

"I am flummoxed by the announcement associated with this chatty article that indicates that for state and teacher employees, there will be no mental health parity BUT this is something good to have access to. What??

This is, unfortunately, nothing new, because the NC State Legislature allowed BCBSNC to 'opt out' of mental health reform law two years ago. Besides mental health services, BCBSNC disallows or makes so difficult that you could consider it disallowed, other important services,such as screening colonoscopies for their insured over age 50.

Medicare and Medicaid will pay for mental health services and they pay adequately for this doctoral level psychologist. Indeed, in using Health & Behavior code billing, the 96152 series of the CPT codes, I am paid at 80%,which is the same level as physicians and physical health billers are paid. If I put in a 'therapy code' e.g., 90804, 90806, 90808, I will be paid the miserable 50% rate. In that Medicare is always primary and Medicaid is secondary,for dually eligible clients, even if I use those 'therapy codes' I am still paid pretty well.

If I have clients that have Medicare ONLY, because they have a few too many assets, say, like they are paying for their trailer in rural NC, then they are deemed to be too 'wealthy' to get to Medicaid and would have to go thru that dreaded 'doughnut hole' which is about $5000.00 of costs before their Medicaid can kick in.

Humana, what I call a 'pretend Medicare' company (remember: tax payers are upshoring these companies to the tune of 18% administrative rates versus less than 5% for Medicare: 'drowning government' is therefore idiocy) will pay for 90808 (70-90 min psychotherapy, which is more useful than 45 min) fairly well, fortunately.

The NC State Legislature has a 'special committee' that 'interfaces' w/ BCBSNC. The members of that committee are: Rand NC senator;;;;;;;;;;;

Moreover, if you look at the e mail address suffixes of those BCBSNC liasons---interfacing w/the above state legislators, they are BCBSNC company suffixes. Thus, the 'legislative liasons' are employees of BCBSNC and they directly tell the NC State Legislature members what to do----and they do it.

There won't be any mental health parity until the government that the private companies are trying to drown are seen to be swirling down the drain.

There won't be any reasonably obtainable screening colonoscopies until 2014, when everyone will get health insurance.

My best advice to people without health insurance,such as myself (I will not pay BCBSNC $1000/ month for three healthy family members w/a $2500 deductible) is to gather up all your medical records, look sick as a dog, get rejected by a private company, and then hike over to Medicare where you can get some REAL health insurance prior to 2014.

Why, you might even be able to get a colonoscopy which could detect colon cancer, associated w/the second most common cancer death. As it is, I would have to drive 3 hours to get to a BCBSNC gastroenterologist to have a colonoscopy that they would pay for, with me paying the specialist fee of $30.

Everyone of those BCBSNC liasons should be made to hold onto a Fleet's enema for 3 hours as just payment for what they help create every working day."


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10:33 PM  
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2:15 PM  

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