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Psychiatric insurance approval takes time in ERs

By Andrew M. Seaman

NEW YORK (Reuters Health) - Doctors spend about 40 minutes getting approvals from insurance companies to get a psychiatric patient from the emergency room to a hospital bed, according to a new study.

In some cases, the researchers found the approval process took more than an hour, which the study's senior author said results in patients being kept in ERs longer and doctors taken away from other duties.

"For anyone who works in mental health, this is nothing new," said Dr. J. Wesley Boyd, from the Cambridge Health Alliance and Boston's Harvard Medical School.

Some insurance companies - except for Medicare, the government-run health insurance program for the elderly and disabled - insist on approving hospital admissions, and without that prior approval may refuse to pay for the hospital stay.

Boyd and his colleagues, who published their findings in a letter to the Annals of Emergency Medicine on Tuesday, tracked 53 psychiatric patients who came to their ER during three months of 2012.

Doctors in the study who felt their patients should be admitted to the hospital marked how long they were on the phone with the insurance company and how long the patients were in the ER.

The median time patients spent in the ER was 8.5 hours, but individual waits ranged from three to 20 hours.

And doctors spent an average of 38 minutes on the phone getting approval from the patients' insurance companies. Half the time, it took less than 20 minutes to get insurance approval, but 10 percent of the time it took more than one hour.

Ultimately, all but one of the patients received insurance approval to be admitted.

"The process is time consuming, but it doesn't really change the fact that someone is going into the hospital," said Boyd.

He acknowledges that the phone calls to insurance companies didn't substantially increase the amount of time patients were kept in the ER, but said it's still added time and keeps doctors from other sick patients.

"You're talking about seriously-ill people being held in emergency settings longer than they should be," Boyd told Reuters Health.

Dr. Steven Daviss, chair of the Department of Psychiatry at Baltimore Washington Medical Center in Glen Burnie, Maryland, said patients aren't typically kept waiting because of insurance approval. Rather, they're usually kept in the ER because of a lack of psychiatric hospital beds available.

"In Maryland they're not waiting over the weekend because of insurance issues, they're waiting because all of the beds in all the hospitals are filled," said Daviss, who was not involved in the new research.

Also, Daviss told Reuters Health that requiring prior approval for psychiatric patients does not mean people are being denied care. Federal law prohibits ERs from turning away patients because of their inability to pay, he said.

In 1986, the U.S. enacted the Emergency Medical Treatment and Labor Act that says hospitals must stabilize and treat people who come to emergency rooms. The 2008 Mental Health Parity and Addiction Equity Act also prohibits insurers from making admission procedures for mental health treatment any more burdensome than for other kinds of conditions.

As a result, Daviss said, fewer insurers are requiring preapproval for hospital admissions of psychiatric patients, at least in Maryland.

"I'm surprised to see that it's still an issue. In Maryland we sort of solved that problem," he added.

SOURCE: http://bit.ly/3J8DYg Annals of Emergency Medicine, online April 23, 2013.

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