The American Psychological Association (APA) and its affiliate, the California Psychological Association, have filed a lawsuit against Aetna U.S. Healthcare alleging that the HMO advertises better mental healthcare benefits than it actually offers.
The suit, filed Sept. 28, charges Aetna with deceptive advertising in California where it promotes its mental health coverage as prompt and accessible. The APA cites these examples:
- Advertising to state employers, employees and citizens claiming a mental health treatment benefit of 20 to 50 outpatient visits per year with its contracted mental health providers. The contracted provider organizations, however, regularly impose an undisclosed four-visit limit.
- Routinely disregarding mental health practitioner determinations of medical necessity for mental health treatments.
- Frequently delaying treatment authorization requests for mental health treatments.
APA's claims have no merit, said Aetna's PR manager for the West region, Bob Pena. He refused to comment on details of the case because it's in litigation.
The Aetna case is indicative of other health plans that misrepresent their mental healthcare coverage, says Russ Newman, the APA's executive director for professional practice. "There is no disclosure of incentive plans, and HMO subscribers are led to believe that their mental health needs will be met," Newman says
"In actuality, the coverage is limited and many patients don't like to talk about it because they are often embarrassed."
The lawsuit is part of the APA's overall strategy to raise national consciousness about how managed care companies make mental health treatment decisions and how limited coverage affects quality of care.
Other mental health advocacy initiatives by the National Alliance for the Mentally Ill (NAMI) hit a brick wall in California. Governor Wilson (R) vetoed a bill last month that would have required HMOs and insurers to provide coverage for biologically based severe mental illness. The veto came after months of legislative compromises, broad grassroots support from letter-writing campaigns and favorable newspaper editorials, says Susan Dore, a senior legislative advisor for NAMI.
The veto also has broader social implications, helping to sustain the widely-held misconception that mental illnesses are less easily diagnosed, serious or life-threatening than other biologically-based diseases, says Dore.
NAMI, however, is making legislative strides in getting state regulators to prohibit mental health discrimination. So far, 19 states have passed bills to prevent discrimination, including: Arizona, Arkansas, Colorado, Connecticut, Delaware, Georgia, Indiana, Maine, Maryland, Minnesota, Missouri, New Hampshire, North Carolina, Rhode Island, South Carolina, South Dakota, Tennessee, Texas and Vermont.
(APA, Russ Newman, 202/336-5910; Aetna, Bob Pena, 925/941-3000; NAMI, Susan Dore, 703/524-7600)