A psychologist friend: Insurance trying to force her patient to take medication.

[Ilsa]

My friend got a phone call from a psychologist, not one that has medication prescription authority, that works for the patient's insurance company a few days ago. The insurance psych person was telling the therapist that he/she thought the patient should be on medication since my friend was treating the patient for depression and had been giving him/her therapy for awhile (I don't know if it was several months or a year).

My friend told the insurance company psychologist that such a demand was unreasonable, given that meds don't work all of hte time, may be poorly tolerated, the patient might want to get pregnant, etc. She also told the company psych that neither of them had Rx authority.

After her conversation, she did some research and discovered that more insurance companies are working this angle now to find a way to deny claims for therapy for depression. I encouraged my friend to notify her state board of insurance.

[ThomCat]

1. How is that not practicing medicine without a license?

That insurance company psychologist, and the insurance company, really should be facing charges for that.

If this can be documented as widespread behavior then this should be a class action lawsuit against them.

Especially if the goal can be shown to be denying claims, that would be fraud.

Can an official complaint be filed with the state's Attorney General? Is there a professional ethics or standards board that could be contacted?

That is just outrageous. :grr:

[elehhhhna]

6. Fristian. It's downright Fristian.

[cbdo2007]

11. What makes you think they dont' have a license?

Most insurance companies departments that manage the mental health portion have to hire licensed psychologists to deal with this. I'm sure this person has a license or else they couldn't have gotten the job.

[Ilsa]

13. My friend said the person has a counselor's license, but not a license

to prescribe medications. She asked.

[cbdo2007]

19. right, the counselor license people review the cases with licensed psychologists who can

prescribe medication. In many cases they have to get it reviewed by multiple psychologists who can prescribe medications before they'll make their recommendations to the person on the phone.

[ThomCat]

21. At the very least,

How is it responsibly practicing medicine if they have not examined that patient?

If you have haven't done a medical exam of that person, you aren't practicing medicine responsibly, you are performing a bureaucratic function and using your license as cover. Practicing medicine requires some direct knowledge of the patient.

[Chemisse]

22. +1

[Sgent]

24. Psychologists

can only prescribe in 1-2 states, and only after additional training beyond their Ph.D.

Psychiatrists are the MD's.

[dog_lovin_dem]

27. Are you certain that you're not thinking of a psychiatrist?

In Illinois, anyway, an M.D. has to sign off on treatment plans and prescribe meds, even if a licensed psychologist is providing therapy. I am a formerly licensed counselor/mental health professional and that was the procedure at the agency I worked for. I don't know how this is done in other states...

[Jackpine Radical]

29. Psychiatrists are MDs and prescribe meds.

Psychologists are PhDs and, although licensed as psychologists, don't have prescription privileges in most states. (Except LA, NM, the island of Guam, and a few in the military).

[hyphenate]

34. I don't know across the board

but AFAIK, psychologists are not able (by law) to prescribe medication of any kind. OTOH, psychiatrists ARE medical doctors with extra degrees, and CAN prescribe medicine. So in this case, the psychologist could not give the patient anything pharmaceutical in nature.

Most people go to their GP for meds, and the GP will send them to a psychologist for dynamic or "talk" therapy, and that's fine for the average patient. When there is a need for stronger measures, the patient might get sent to a psychiatrist who will work with the patient to find something that works better.

[bobbolink]

12. Excellent point! I hope the psychologist in question will look into this...

And, even more important, I hope patients will start demanding action on this!

It is collusion!

[SoCalDem]

2. Insurance companies know that it's cheaper to use meds

than to use in-office talk-therapy. :(

[csziggy]

8. Last research I read, anti-depression meds work best WITH therapy

And not all that well by themselves.

[JoeyT]

10. Yeah, that's the general consensus.

Besides the therapy actually helping the patient, the therapy helps to reinforce the treatment routine. So it increases compliance with the medication routine/dosages. Depressed patients have terrible rates of medication compliance without the therapy.

[hyphenate]

35. I know--

I'm one of them. But it's my insulin that I hate to comply on--and no lecture from anyone will help, only make me more stubborn! OTOH, my anti-depressant has made me physically dependent on it, and to go off it cold turkey would make me a basket case. So I dare not do that easily!

[Ilsa]

14. +2. Meds Can be good, but therapy is helpful, even if meds aren't doing the job. nt

[SoCalDem]

20. True, but the insurance companies prefer more med-less talk

It;s been that way for a long time, and will probably get worse now:(

[Jackpine Radical]

30. Indeed. The meds basically suppress the symptoms

instead of treating the basic problem. However, insurance cos. have learned that people tend to move from one company to another (I think on average every 19 months or so), and it's cheaper to suppress the symptoms for as long as the person is on their plan than to fix the problem. Prozac, for example, being out of patent, is about 10 cents a dose.

[boobooday]

3. Pills Pills Pills Pills

Cheap, make you go away, make a profit for Pharma, and save money for Big Insurance.

[NC_Nurse]

4. That sucks. Many of those meds have side effects and are dubious in their

benefit. I bet they get a deal from the pharma co's so the person will be stuck on them for years. What a scam.

[Ilsa]

16. Isn't it though? And I take an antidepressant myself. But I have

some side effects that I deal with. Not everyone would want my side effects.

And I tried a different drug, and it was supposed to work like the first one, but it made me downright despondent. Psych meds are tricky business.

[Jackpine Radical]

31. Mean treatment effect size of antidepressants is actually quite small.*

Several studies were suppressed by the drug companies in which the meds didn't beat "active" placebos. Researchers later ferreted these studies out. Also, read Peter Breggin's Talking Back to Prozac. An old book, but still on-target.

*If you're familiar with Cohen's D, the mean D value was .31--a barely detectable treatment effect.

[elocs]

5. I wish I didn't have to read this several times to figure out the point.

Most psychologists cannot prescribe drugs because most do not have prescription authority and they are not medical physicians. Psychiatrists are medical doctors and they can prescribe medications.

So, exactly how are insurance companies using this as an angle to deny claims for depression therapy?
:shrug:

[Ilsa]

17. They want to move the client from a psychologist to a psychiatrist

so the med doc can Rx the drugs, but do less therapy. That is one way.

The second point is that an insurance person who has no access to the patient is presuming to know what is best for said patient.

[elocs]

23. So again, how exactly is this being used to deny coverage? n/t

[Ilsa]

25. The patient has an established relationship with his or her current

counselor/psychologist. Seems to me that if the insurance company stops paying for those sessions because they want the patient on drugs, then the patient has to change to a psychiatrist to have that done to appease the insurance company.

Maybe the insurance will continue coverage, but only if they see a doctor that costs more, but delivers fewer sessions because they've drugged up the patient for the next six months to a year. In any case, the insurance company is deciding the treatment for the patient, not the patient with his/her therapist.

[rucky]

7. I got way more benefit out of therapy than meds.

this is short-sighted bullshit policy.

[blogslut]

9. Therapy/Counseling is vital

Meds or not.

[Sienna86]

15. Mental health parity is coming in January 2010

That may be the reason.

[Ilsa]

18. Is this under the new health care plan, or an old one where coverage is

being grandfathered in? I'm not up on my insurance and law.

[Nikki Stone1]

26. And soon, we'll be mandated to give these companies money--or be fined/jailed.

That could make me depressed.

[BlueIris]

28. Great. Ew. nt

[undergroundpanther]

32. talk therapy VS pills

For me talk therapy is vital. I have PSTD,depression,and other labels.One thing that pisses me off is
SOME people mainly for profit companies(big pharma/insurance co's and veterans admin.) Do not want PSTD
to be recognized as a legit psychiatric injury. PSTD/psychiatric trauma injuries appears as ,hurts like one.. it is a mental illness and a genuine physical injury that causes specific symptoms and it responds to talk therapy and sometimes medications.PSTD leaves scars in the brain. The mental illnesses like depression do not cause the type of brain scars seen in PSTD. If PSTD is no longer pooh poohed,it means people will have to stop abusing each other,that wars will have to cease,that spanking a child is wrong,being a psychopath threatens the mental health of everyone around said psychopath,torture really injures people far beyond the visible scars,rape and pedophilia is a severe human rights violation,natural disaster victims need help beyond cheesy asbestos infested trailers and things like bullying, abuse and hazing threaten the mental health of the nation.


What was the first reaction to soldiers with PSTD? The reaction was the reaction an abuser or bully would have twords someone who was injured by the bully..They belittle and blame the injured person.Telling them to"toughen up" quit being hysterical and to shut up.If they didn't straighten up some soldiers were murdered for having PSTD..



During the Great (sic) War of 1914-1918 around 9 million men lost their lives in one of the greatest acts of barbarity and futility the world has ever seen. This compares to an estimated 14 million deaths during all wars in the previous century. The heroism and sacrifice of troops in the trenches is probably without parallel. However, during the war, 306 British and Commonwealth soldiers were shot on the orders of military top brass and senior officers. In contrast, the Germans only executed 25 of their own. The Americans executed none of their soldiers.

The pretexts for execution for British soldiers had a common theme: many were suffering shell shock (also called "war neurosis" or "combat stress" and now recognised as Post Traumatic Stress Disorder or PTSD), and most were deliberately picked out and convicted "as a lesson to others". Charges included desertion (walking around dazed and confused suffering from PTSD), cowardice (ditto), or insubordination (any minor action that could be pressed into service as an excuse for execution). Some were simply obeying orders to carry information from one trench to another. Most of those shot were young, defenceless and vulnerable teenagers who had volunteered for duty. They were selected, charged, and subjected to a mock trial often without defence one day, convicted, then shot at dawn the following day. Eye-witness accounts suggest many faced their death with a gallantry absent in their accusers.



General Haig, when questioned, declared that all men accused of cowardice and desertion were examined by a Medical Officer (MO) and that no soldier was sentenced to death if there was any suspicion of him suffering shell shock. The Under-Secretary of State for War also and repeatedly misled the House of Commons on this matter. In fact, most soldiers accused of cowardice and desertion were not examined by an MO, and in the few cases where a medical diagnosis of shell shock had been made, the medical evidence was rubbished or ignored and the man was convicted and shot anyway. General Haig not only signed all the death warrants but when questioned later on this issue lied repeatedly. General Haig's behaviour in choosing to murder his own men places him in the category of war criminal.

http://www.bullyonline.org/stress/ww1.htm

[benld74]

33. One pill make you larger, One pill makes you small,,,

Jefferson Airplane
White Rabbit

[mdmc]

36. --