Dr. Selahattin Kurter
Although Dr. Selahattin Kurter spoke for only five minutes at the Milwaukee City-County Heroin, Opioid, Cocaine Task Force two weeks ago, he made sure his voice was heard loud and clear. Dr. Kurter, who is board certified in addiction medicine as well as psychiatry and neurology, has been working with those who suffer from addiction in Milwaukee for more than a decade. His message to large private insurers across the region was short and sweet—stop denying services to those providing addiction treatment in Milwaukee.
“When it comes to providers, they are playing two face,” said Dr. Kurter. Insurers are limiting access for addiction treatment through unnecessary prior authorizations according to Dr. Kurter, offering different reimbursement rates for mental health doctors compared to medical doctors and enforcing unnecessary medical guidelines. Dr. Kurter said these insurance providers are breaking federal laws because of this, specifically the 2008 Mental Health Parity and Addiction Equity Act.
This law prevents health insurance issuers that provide mental health or substance use disorder benefits “from imposing less favorable benefit limitations on those benefits than on medical/surgical benefits,” according to the act. “It’s not for lack of treatment,” Dr. Kurter said. “We have excellent treatment options that help these people get better. It’s really insurance companies limiting access to treatment.”
Dr. Kurter is the medical doctor executive director at the West Grove Clinic, an addiction center in Milwaukee. He provided multiple examples of insurers negatively impacting the treatment he provides. He said that some insurers put a limit on the amount of drug screenings he can perform. He said that in some cases, comparable physicians get paid more for offering the same treatment, mentioning that a doctor in rheumatology might get 50% more in payments compared to a psychiatrist treating the same illness. He also said that higher authorizations for treatment, such as a higher authorization relating to withdrawal medications, could delay treatment for those in need. Dr. Kurter mentioned that sometimes anywhere from 15-45 minutes of delays can negatively impact a patient.
Parity Law
The Mental Health Parity and Addiction Equity Act was amended in 2010 to also apply to individual health insurance coverage. Overall, this law says that mental health and substance use benefits must be comparable to those used in surgical and medical benefits. The State of Wisconsin Office of the Commissioner of Insurance says that through the law, inpatient and outpatient services as well as transitional treatment services must be covered by insurers.
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However, a 2017 report done by the independent research agency Milliman said that medical and surgical providers “received higher reimbursement rates than behavioral health providers for comparable services.” The report said that in 2015, medical/surgical providers were paid on average between 15.2% and 11.3% higher than Medicare allowed amounts, while behavioral health providers were paid about 4.9% less than Medicare allowed amounts.
Parity Track, a national forum that tracks parity implementation, ranks Wisconsin as an “F” regarding legislators holding insurers to their word regarding parity law. The Shepherd reached out to current Wisconsin Attorney General Brad Schimel and incoming Attorney General Josh Kaul regarding this, but neither responded. We also reached out to multiple state legislators, but no one responded to multiple inquiries regarding implementation of the law.
Medication Assisted Treatment
Drug overdoses have killed 1,700 individuals in Milwaukee County over the past five years. In 2017, nearly 400 people across the county died from opioid-related deaths. That number is almost five times as high as opioid-related overdoses the previous year. Many substance abuse providers believe that Medication Assisted Treatment (MAT) can help lower the number of deaths in the city, state and nation.
MAT, or the use of FDA- approved medications in combination with “counseling and behavioral therapies” according to the FDA, is widely viewed as a very successful practice in fighting the battle against the opioid epidemic. The Shepherd asked some of the largest private health insurance providers, including Cigna, Anthem Blue Cross Blue Shield and United Health Care if they could provide how many MAT providers they have within the City of Milwaukee. All three providers could not provide an exact number.
A spokesperson for United Health Care said, “We are committed to urgently addressing the opioid epidemic, meet all state requirements and are actively expanding our medication assisted treatment network across Wisconsin as more providers become certified and are choosing to join our network.” A spokesperson for Cigna said, “Cigna views substance use disorder as a preventable, treatable chronic condition, and we are committed to ensuring our customers have access to high-quality addiction treatment and behavioral health care services as well as other tools and resources to support their health and well-being journey.” A spokesperson for Anthem Blue Cross Blue Shield did not respond to multiple inquiries regarding this question.
These answers aren't enough for Dr. Kurter. “They’re skirting around providing treatment, primarily because no one is holding them to the fire,” he said. “The laws are in place so it’s up to the state to enforce it, but the states are not enforcing it for a variety of reasons… I feel like that’s the crux of why this is an issue.”
You can read the Milliman report that tracks insurance companies regarding parity laws here.
