Insurance company examiners in Massachusetts say emergency room patients who need behavioral health care seem to wait longer for beds than patients who need other types of inpatient care do. But the patient records are incomplete, and it's not clear whether health insurers are contributing to the delays with any violations of the federal Mental Health Parity and Addiction Equity Act (MHPAEA), state officials say in a new behavioral health examination report.
"The records do not have enough information to draw conclusions, especially since the records are not consistent from one carrier to another, or even within a given carrier," officials say.
Officials in the Massachusetts Division of Insurance prepared the report using information from outside reviewers at Dixon Hughes Goodman L.L.P.
The reviewers looked at patient records in the offices of nine health insurance carriers. The reviewers looked at 25 non-behavioral health records for each carrier, and 50 behavioral health records for each carrier.
The reviewers found that 40 of the 225 non-behavioral health patients were admitted to an inpatient hospital bed straight from the emergency room. And that 341 of the behavioral health patients went from the emergency room to an inpatient behavioral health bed.
The reviewers found that none of the non-behavioral health patients and 13 percent of the behavioral health patients spent more than 24 hours in the emergency room. In many cases, the reasons for delays were not well documented, and the record failed to give complete information about what happened to the patient when, officials say.
Officials describe one case of a patient who waited to get inpatient care while the patient or the patient's family appealed a denial of admission to inpatient care. In some of the other cases, patients clearly had authorization for inpatient care from their insurers, but finding an available bed took more than a day.
Private insurers' use of emergency service treatment reviewers seemed to delay insurer admission decisions in some cases, but simply finding available, appropriate behavioral health beds was also a problem, officials say.
Because any non-behavioral health care sought was almost always in-network, the reviewers had a hard time comparing the effects of in-network utilization policies for behavioral health and non-behavioral health patients.
Officials note that leaving patients in need of emergency behavioral health care in emergency rooms for an extended period delayed the patients' access to appropriate care and placed demands on the emergency room staff.