5 lessons learned for providers and payers
The court's ruling contains several lessons for providers about their own practices and that of their patients' insurers:
- Financial self-interest should never be a critical consideration as to whether or not to offer coverage.
- Insurers should not give their finance department the equivalent of veto power over medical and patient care decisions.
- Make sure you are meeting or exceeding the generally accepted standards of care in the behavioral health field, as public support for quality behavioral healthcare will continue to increase.
- Know that courts are willing to enforce the quantitative and qualitative components of the Parity Act.
- Be aware that level of care and coverage determination guidelines can form the basis for fiduciary duties between a covered member and his/her insurance company.
Supplying and encouraging quality patient care is an expected duty. It is not a responsibility that should be taken lightly and certainly one that should never be sacrificed on the altar of financial self-interest.
Erica A. Erman, JD, is an associate attorney at Dickinson Wright in Phoenix, Ariz. Her practice areas include healthcare, behavioral healthcare, appellate, and general litigation law. Prior to joining Dickinson Wright, she served as a Judicial Law Clerk to the Honorable Robert M. Brutinel of the Arizona Supreme Court. Erica graduated cum laude from the James E. Rogers College of Law at the University of Arizona.