BCBS of Illinois drops mental health pre-approval

Blue Cross and Blue Shield of Illinois has dropped a plan to require subscribers to get prior approval to access a broad range of outpatient mental health services, the Chicago Tribune reports.

The state's largest health insurer upset mental health providers and their patients in recent weeks with the pre-approval requirement for mental health, according to Chicago Breaking Business. Mental health professionals said the plan would violate a federal law that requires equity in how health plans treat medical and mental health services, notes the St. Louis Post-Dispatch.

"This would have served as a subtle deterrent to getting care," Paul Pendler, a clinical psychologist in private practice in Chicago, told the Tribune. "Anytime you put limits or a requirement to precertify for access to services brings a higher likelihood that people will say, 'Forget it,' and not get treatment."

Complaints drew interest from Illinois Insurance Director Michael McRaith, whose staff has been meeting with Illinois Blue Cross in recent weeks. McRaith says the department will resolve any ambiguity in the law in favor of patients, the Post-Dispatch reports.

The insurer said the intent of its preauthorization program was "to improve coordination of care between medical and behavioral healthcare providers," according to an internal Blue Cross memo sent to mental health providers and obtained by the Tribune. It also was designed to give members "guidance regarding care options and available services based on their benefit plan" and to help "indentify co-existing medical and behavioral health conditions earlier."

Illinois Blue Cross would still have pre-authorization for certain services such as behavioral health partial hospitalization, intensive outpatient programs at facilities, all outpatient electroconvulsive therapy, and psychological and neuropsychological testing, Dr. Scott Sarran, Illinois Blue Cross chief medical officer, told Breaking Business.

To learn more:
- read the Chicago Tribune article
- see the Chicago Breaking Business piece
- check out the St. Louis Post-Dispatch story

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