Delegates Urge Payment Parity in Mental Health, Women's Health Services

"We need to put an end to the games insurance companies are playing."

With those words, Rhode Island delegate John Bossian, D.O., of Wakefield urged the AAFP Congress of Delegates to adopt a resolution that addresses insurance company policies that deny payment or that underpay family physicians for mental health care.

The Congress agreed and adopted the resolution, which directs the Academy to work with the insurance industry to resolve nonpayment or underpayment for mental health care services. It also asks the AAFP to educate business groups, such as the National Business Group on Health, about family physicians' expertise in providing mental health care.

Payment denial or underpayment for mental health care is sporadic and takes on different permutations, depending on the company and the region of the country, said FPs in testimony before the Reference Committee on Health Care Services. Some companies won't pay for any mental health codes, but do pay for codes that apply to treatment of physical effects such as fatigue or chronic headaches. Other companies pay for mental health care, but only when it's provided by a psychiatrist, psychologist or advance practice psychiatric nurse, according to Bossian.

Some of those policies stem from insurers' business models. Several insurance companies retain behavioral health companies to provide psychological services to subscribers, noted Missouri alternate delegate Lawrence Rues, M.D., of Kansas City. "So their attitude is, 'We hired Company A to do this; we don't want to pay (community-based) doctors to do the same thing,'" he told the reference committee.

A similar dilemma plagues well-woman health checkups. Women who seek Pap tests from gynecologists often fail to seek comprehensive annual physicals from their family physicians.

"The insurers see the Pap as the annual physical, and they don't pay for two physicals a year," said Pennsylvania AFP President-elect Bradley Fox, M.D., of Fairview during committee hearings. When women do seek well-woman checkups from family physicians, insurance companies often bundle Paps and pelvic examinations with the comprehensive exam.

"Insurance companies will pay the family physician for a physical exam and the gynecologist for the Pap, but not the family physician for both," said Rhode Island delegate Margaret Sun, M.D., of Riverside.

In the first step to resolve the issue, the Congress of Delegates asked the AAFP Board of Directors to develop a policy statement on coding and payment for preventive services for women, with and without breast and pelvic examinations.