Preauthorization Requirements Less Onerous

Over the past year APA's Committee on Managed Care has been surveying major managed behavioral health care organizations (MBHOs) to determine whether they have changed their preauthorization policies to make it easier for patients to see a psychiatrist.

The general finding is that MBHOs are moving toward fewer preauthorization requirements, at least for an initial number of visits, but policies vary from company to company.

In February 2004 Lawrence B. Lurie, M.D., chair of the Committee on Managed Care, sent letters to the presidents of CIGNA Behavioral Health, Magellan Health Services, MHN, PacifiCare Behavioral Health, United Behavioral Health, and ValueOptions outlining concerns that preauthorization requirements are overly burdensome and create a roadblock to accessing psychiatric care. He also asked the MBHOs whether they had been making changes in their preauthorization policies, and, if so, what effect this has had on access to care and costs.

CIGNA responded that it does not require preauthorization for routine outpatient care and provided a list of 15 examples of nonroutine care, including care for ADD/ADHD and for depression in excess of 12 sessions without an evaluation for medication. ValueOptions said that it has eliminated medication-preauthorization requirements, but it requires reviews after a certain number of psychotherapy visits as defined in specific contracts. PacifiCare responded that it allows 12 initial visits for psychotherapy or medication without preauthorization. MHN said that its preauthorization requirements vary widely according to individual contracts.

Commented Lurie, “These are steps in the right direction. Any reduction in preauthorization requirements reduces psychiatrists' administrative costs and hassles. Reducing the time psychiatrists must spend filling out preauthorization forms gives patients more access to care.”

Committee members are continuing to seek information from Magellan and United Behavioral Health. ▪