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The figures quoted in the article on managed care denials in the January 16 issue are meaningless. They do not take into account the number of patients who simply drop out of treatment because the obstacles to getting consent are so great. Often the therapist receives only a message that someone has canceled out of treatment without giving the reasons.
Secondly, while total denial may be less frequent, it is very common to receive consent for treatment only at long intervals between visits and frequently only for very brief visits. Often the company will specify only code 90862 for medication management-which means it is not classified as a denial of treatment but in fact is a denial of adequate treatment.
Moreover, something the figures will never reveal is the decisions made about treatment because of totally inadequate fees for psychotherapy, again severely limiting but not totally denying treatment.
Finally, certain carriers make it so difficult as to be almost impossible to reach them to discuss a case and obtain authorization. In one case this week it took over half a day to do so and another two hours to have the company review the matter and get back to the care providers-an approach that frequently leads both patient and therapist to give up. In a practical sense, it is impossible to spend the amount of time required, often to reach a reviewer or case manager who is arbitrary and sometimes lacking in common courtesy.
Like many statistical studies, the results are at odds with the reality of the situation. Many psychiatrists simply don't respond to the pollsters because of a sense of absolute futility, but accurate data again and again have failed to impact the system of managed care in a reasonable fashion.
Harold J. Levy, M.D.
Buffalo, N.Y.