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Commentary by Butler doc in the NY Times

January 4, 2011

One of little Rhody’s own doctors talks candidly about the challenges of providing emergency  health services to psych patients in a recent commentary in the  New York Times.

Dr. Paul Christopher offers a personal example of a phenomenon detailed by Felice Freyer in the Projo– although emergency rooms are supposed to accept all patients, regardless of their ability to pay, there’s a double standard for folks with mental illness.

Only a few hospitals in Rhode Island are charged with accepting so called “state” patients who cannot pay for their own care.  When those facilities are full, uninsured residents with mental health needs can wait days for emergency care.

Christopher illustrates the problem with a story about a patient with a high alcohol blood level who is prone to seizures when he stops drinking.  Christopher wants to put the patient on a medical detoxification regime, but first he has to jump through multiple insurance hurdles.

…nearly all mental health admissions, no matter the reason, require authorization from insurance companies. Otherwise, the admitting hospital won’t get paid. Although this patient wasn’t coming into my facility, we were the first point of clinical contact; and because I was the one recommending admission, it fell to us to justify that decision to the insurer. The short straw was ours.

A bad situation was beginning to look worse. The insurance company wouldn’t authorize an admission until my patient had been accepted to a bed, but he couldn’t be accepted until he’d been medically cleared.

You’d think that the recently enacted Mental Health Parity and Addiction Equity  Act would have solved this kind of inequity.  Christopher says no such luck-

And legislative reforms like the recent Mental Health Parity and Addiction Equity Act, while helpful, have yet to be the Alexandrian sword that so many hope for. Too many patients with substance disorders are still unable to get the prompt care they need and deserve.

In the end, Christopher ends up recommending that the patient stay at Butler, even though it’s not a designated “in network” hospital where the state will pay for uninsured patients.  He notes that Butler will probably end up “eating the cost” of  the patient’s care, but it’s the right thing to do.

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