UBH Responds

We have reviewed the article "MH Carveout Takes New Twist To Denying Psychiatric Claims" published in the September 18 issue. We were extremely disappointed that the reporter did not contact United Behavioral Health for our response to the issues raised prior to the article's being published. This lack of basic journalistic fairness led to the publication of an article that is inaccurate and misleading. We would like to clarify the following:

• Upon hearing from officials at Butler Hospital that claims for dementia were being denied, our staff conducted an investigation. We found that the claims were inadvertently denied when they should have been paid. The situation was immediately corrected.



• The article implies that United Behavioral Health seeks to "redefine the diagnosis of dementia" and "to limit the number of physicians who can be reimbursed for treating Alzheimer's disease." This is categorically untrue. Our organization supports the treatment of dementia by psychiatrists as well as by other health care professionals when clinically indicated. Dementia is a complicated disease and may require the intervention of general physicians, medical specialists, and psychiatrists and other mental health care providers to ensure that the patient receives the best level of treatment. In such cases, UBH manages the behavioral health care services and coordinates with the patient's health care plan for payment of non-behavioral health care claims.



• The quotes attributed to Ann Davidson, M.D., imply that she was responding to Psychiatric News when indeed she had never been contacted. The "quotes" are from a letter Dr. Davidson wrote to the State of Rhode Island and are clearly taken out of context.



• The issue of patient confidentiality is an important and complex one that continues to be worked out among state legislatures, patient rights groups, health care professionals, and insurance companies. The insurer has the responsibility to let patients know the status of their claims. Physicians have a key role in informing patients about diagnoses or when diagnoses are being investigated.



• Finally the article inaccurately states that United Behavioral Health wants to avoid financial responsibility for these services. This is untrue and misleading. UBH is not financially at risk for these services, but is responsible for managing the behavioral health benefit for the patient's health plan. In this case UBH was simply ensuring that the appropriate health care plan provide reimbursement. We strive to make this a seamless process for the providers and patients and are constantly looking for ways to improve our systems.

As fellow psychiatrists and members of the American Psychiatric Association, we were extremely disappointed that one of our own medical association's newspapers chose to rely on anecdotal information aimed, it appears, only at further politicizing the issues of managed behavioral health care as opposed to presenting a balanced and fair perspective on these critical issues.

David Nace, M.D.
Chief Clinical Officer
United Behavioral Health

Sunil Sachdev, M.D.
Corporate Medical Director
Health Plan Division
United Behavioral Health

Editor's note: We are pleased that the situation of inadvertently denied claims was corrected. We appreciate that those involved have different views of the meaning of the denied claims. We believe our report accurately reflected the written responses of UBH and UH representatives regarding the issues in question.