Medicare Billings for Mental Health Care

Re “Medicare’s Crackdown on Fraud Stirs Debate,” Nov. 10:

The California Psychological Assn. wholeheartedly supports eliminating waste and abuse in the Medicare system. However, the present utilization review system for Medicare-covered mental health services is interfering with the care provided to many beneficiaries. The current system of arbitrarily denying claims gives patients little certainty that they will continue to receive needed services.

The effectiveness of combination drug and therapy treatment for the chronic mentally ill is well-documented and supported by a majority of mental health professionals. Rather than debating this fact, we should look at the way the system of reimbursement identifies and reviews benefits coverage. The expense and time required for a practitioner to participate as a Medicare provider makes for a grave disincentive to offering care. The needs of Medicare patients deserve to be the top priority of all involved in this system.

SANDRA R. HARRIS, President

California Psychological Assn.

Sacramento

* There is no question that there are unethical mental health practitioners who are exploiting the system. Our professional societies, at times, have been negligent in not speaking out against these violations and in not punishing these corrupt practitioners.

However, we must be equally cautious of adopting the bottom-line ethics of insurance companies and managed care companies. Chronic mental illness is not the result of moral laxity, nor is it a tranquilizer-deficiency disorder. Medication often helps in symptom amelioration but the rehabilitation of these patients is a long and arduous process. It cannot be achieved in 20 or fewer sessions. These patients and the dedicated professionals who continue to work with them should not be stigmatized by the implication that their efforts are an attempt to milk the system. Likewise, a system requiring repeated and arduous justification for needed services ultimately ensures that these services will not be given, a fact of which providers are well aware.

If we are not going to help support and treat the victims of chronic mental illness, we should own up to what we are doing and not become moralistic and judgmental about those who suffer from mental illness.

RICHARD P. FOX MD

Tustin