American Psychiatric Association

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Letter sent to the Department of Labor Secretary on May 25, 2022 expressing APA and Path Forward’s concerns over lack of regard for the Mental Health Parity and Addiction Act.

Quotes from Member Psychiatrists Included in the Letter

“Prior authorizations are the bane of my existence. Denials become more outrageous every
year. It is absolutely unbearable. I would retire for this reason only but I will not abandon my
patients and I will not stop fighting for them.”

“Each year, I have to fight with insurance to renew longstanding medications that are needed to
prevent hospitalization (long-acting injectable antipsychotics) or relapse (buprenorphine) for
patients that have repeatedly failed other treatments. Sometimes these are only renewed for 3-
6 months at a time, requiring serious administrative burden that is not reimbursed. Some of
these, such as Blue Shield, split the appeals process across three or four divisions (medical
authorization, mental health authorization, mail-order pharmacy, specialty pharmacy) and place
the onus on the clinician and patient to coordinate among these divisions. All of this is harmful
to patient care, and an ongoing injury to clinician morale and finances for all of this
unreimbursed care.”

“I am a child psychiatrist who would love to accept commercial insurance and see the children
of working people. The administrative burden, risk of inappropriate audit/financial loss, and
laughable reimbursement rates make it impossible to take this risk as my family’s primary
breadwinner. If commercial insurance companies reimbursed us better (including adjusting for
cost of living in higher COL areas like the northeast) and did not threaten us with arbitrary
audits/UR/pre-auth/etc., I would take insurance to do good for my community.”

“The supply and demand dynamics are not reflected in reimbursement. Very tempting to move
to self-pay model for that reason, but I feel morally obligated to provide care to long term
patients. If reimbursement doesn’t improve, we will have to make a choice, since the
administrative costs keep climbing up. Reimbursement hasn’t even kept up with inflation, let
alone reflect supply and demand dynamics.”

“Claw-back audits killed me and insurance; I was the last psychiatrist in my county to stop taking

APA Member Psychiatrists