| 
Psychology Gains Significant
Concessions in Lawsuit Settlement
The lawsuit filed by the Virginia Academy of Clinical Psychologists
and several individual psychologists, a plan subscriber, and a patient,
against the company now known as CareFirst, as well as the managed care
company’s mental health subcontractor and some related managed care
companies, was settled in mid-March. In a press release announcing the
settlement, the American Psychological Association (APA) Practice Organization
announced that psychology had wrested significant concessions in the settlement.
The suit accused the company (known then as Blue Cross/Blue Shield of
the National Capital Area) of fraudulent and unlawful marketing, creating
a “phantom panel,” interfering with therapist-patient relationships,
and breaching contracts with both psychologist providers and patients.
A trial on the contract breaches was scheduled for April 7. The settlement
reached late Friday “is tantamount to full capitulation by the companies
and makes a trial unnecessary,” said Russ Newman, PhD, JD,
executive director for professional practice at the APA. The APA supported
the lawsuit from the very beginning.
In the settlement, the companies agreed to give VACP, the psychologists
and consumers everything they could have won at trial, and preserved their
rights to appeal all claims that had previously been dismissed by the
court.
The suit was filed after CareFirst unilaterally reduced reimbursement
rates by 30% over Thanksgiving weekend in 1997. The rate reduction was
presented to providers as a “take it or resign” deal, and
according to public court documents, resulted in a flood of provider resignations
that left at least 250 patients needing to find new therapists mid-treatment.
Ironically, at the same time, CareFirst was publicly trumpeting that its
merger of the DC and Maryland plans would create a broader and more accessible
provider network.
“The settlement includes an acknowledgement by the companies that
their provider contracts should not be interpreted to allow unilateral
rate reductions over the objections of the psychologists,” Newman
said. “This gives us good ammunition the next time a managed care
company tries to use strong-arm tactics to put profits before patients.”
These tactics by CareFirst were recently cited as evidence in Maryland
Insurance Commissioner Steve Larsen’s rejection
of the company’s proposed merger with Wellpoint Health Networks.
Larsen used this case to underscore how such hardball tactics are not
in the public interest and negatively affect quality of care and provider
network adequacy.
The settlement also involved payment of all money that could have been
awarded from a win at trial for the breaches of contract—more than
$35,000 to the psychologists as well as more than $50,000 to the consumers
involved in the case.
“This case is about much more than the money,” said Newman.
“Managed care companies that act to put profits before patients
must be held accountable.”
Practice Directorate Conducts
Survey on War and Terrorism
225 psychologists, reporting on one randomly determined client, completed
the APA Practice Directorate’s most recent Internet- based PracticeNet
survey. The survey was conducted March 20-24, 2003, to assess client and
psychologist responses to the beginning of the war in Iraq. Fifty five
percent (55%) of clients were female, the average age of participants
was 35 years, and the majority of clients were white. Thirty-eight (38)
clients were children ranging from 2 to 17 years old.
Forty two percent (42%) of clients brought up the war or terrorism during
the specified clinical encounter. Emotional responses included:
Anger – 41%
Sadness – 35%
Distress – 45%
Apprehension – 66%
Twenty-nine percent (29%) of clients are experiencing increases in symptoms
or the onset of symptoms in response to war and threats of terrorism.
Generalized fear and fear or uncertainty about the future are prominent
symptoms. A small number of children have evidenced onset or increase
in symptoms but generally they are exhibiting less increased distress
than adults as a result of war and terrorism.
Psychologists reported that 69 clients (33%) are personally impacted
by the war and threat of terrorism in a variety of ways including:
15 have family or friends in the military or reserves
43 live or work in proximity to possible domestic targets of terrorism
6 have family or friends in the Middle East
Therapists seeing clients in rural areas reported fewer personal impacts
on their clients than therapists reported on clients in non-rural areas.
There were no differences among clients in major urban areas, suburbs,
and smaller cities and towns. There also were no significant differences
among racial groups in the extent of personal impacts.
Twenty-six percent (26%) of psychologists reported no cumulative effect
of hearing about clients’ concerns regarding war and/or terrorism,
while 40% reported being “a little bit” affected, 25% “somewhat”
affected, and 9% “quite a bit” or “a great deal”
affected.
Back
to May/June homepage |
