Bailing out on the vulnerable

By Tom Davis

It began when a father told the story of his drug-addicted daughter.

In the mid-1990s, she was being treated by her father's managed health care plan, and she was in the hospital. But the company wanted her out.

Her father pleaded for her to stay. But she couldn't. She left. The next day, she went back to her Long Branch "crack den," overdosed and died.

A widow at 24 - her husband had died of a heart attack - she left behind two children.Russell Holstein, a Long Branch psychologist, had had it already with managed health care. When he heard this story, he took action.

"I read the hospital record, and it made me sick," he said. "What are these hospitals doing?" Holstein recently published a study that he believes will expose the sorry state of managed mental health care in suburban New Jersey.

After two months of research last year, Holstein discovered what he long suspected: The number of psychologists and psychiatrists who accept managed health care plans is dwindling. Some refuse to take certain patients unless they know them, Holstein said.

"You want to work with somebody you know and trust," said Holstein, whose study was published in the Independent Practitioner, a publication that's circulated in the mental health trade. "Fifty-two percent of psychiatrists nationwide are not accepting any managed care at all."

To Holstein, a doctor doesn't want to be saddled with insurance fees and paperwork that's required by managed care.

"They want to make a profit," Holstein said of the insurance companies. "The paperwork from their point of view [gives them leeway to] manage the care and to determine whether it's reasonable."

While the phenomenon may not be new - and it's certainly a problem in all health care - Holstein concluded that it's especially pervasive in communities that lack the resources of urban areas, such as New York City.

"Practitioners want to work in New York City," he said. "We're talking about a major part of the country [that's affected] that is not the desirable urban areas."

In mental health, he says, it's a situation that's quickly becoming a crisis. Mental health care lacks the respect of other health professions, and therefore insurance companies don't want to deal with it, Holstein said.

"Most of New Jersey is suburban. You don't have the resources," Holstein said. "Mental health has always been the poor stepchild in these areas."

Pamela Greenberg, executive director of the American Managed Behavioral Healthcare Association, said managed health care providers "are firmly committed to high standards of quality and accountability."

"Managed behavioral health care organizations insure over 164 million people in the United States and are increasingly turned to as the preferred insurance coverage option for behavioral health care," Greenberg said.

But Holstein and other mental health professionals say the obvious gap in services is perhaps partially responsible for an increase in crime rates in suburban areas - particularly in South Jersey, the focal point of his study.

One such example was Sam Manzie, the Jackson Township youth whose parents struggled to treat his mental illness. He killed Eddie Werner nearly a decade ago when the 11-year-old was selling candy for a school fund-raiser.

The lack of treatment options is a big reason the American Psychological Association is pushing Congress to pass the Sen. Paul Wellstone Mental Health Equitable Treatment Act of 2003.

"They [insurance companies] put limits on the amount of sessions people can have. The doctors have a difficult time getting reimbursed," said Luana Bossolo, a spokeswoman for the APA. "Mental illness is not treated in the same way as other medical issues."

Holstein's study - which focused on his home region of Monmouth and Ocean counties - found that as many as 30 to 50 percent of psychiatrists and psychologists refuse to take new patients in managed health care plans that they normally support.

One example showed that 33 psychiatrists and psychologists accepted Cigna's managed health care, but 13 of them - at the time of the study, which was done in late 2003 - did not accept new patients.

Holstein said he's no angel, either. He, too, has faced the choice of whether to accept new patients. For him, it's a case-by-case decision. But generally, he says, he doesn't.

"I became a sworn enemy of managed care," he said. "There are people who have tried to twist my arm. I like to work with couples, for example. If I have room for them, I take them. But I also realize I may be setting myself up."

Reproduced with permission of The Record of Hackensack, NJ. www.northjersey.com