Copy of a Letter of Inquiry on Disallowed Mental Health Diagnoses

I have a copy of a list of non-allowed MH diagnoses in Maryland that I find disturbing.  I do not know if Optum or BHA make these decisions. I want to raise the issue of re-evaluation of these non-allowed diagnoses such as post-partum depression (F53) and eating disorders (F50.01 & F50.02) and Bulemia (F50.2).  I think at least one of these (Post-partum depression, F50..0) raises a women’s rights issue and a clinical issue and I think it needs to be re-evaluated. I certainly think that Autism and Aspergers as a disallowed diagnosis need re-evaluation. This method of coding reduces the number of services that can be provided for these diagnoses in rural areas, where specialty services are less likely to be found.
 These restrictions come from conventions that result from a view of mental health which does not take into account trauma or the reality that very few people have only one diagnosis.  Many people have multiple diagnoses and all
problem areas need to be treated and resiliency strengthened.
Let me begin by saying that it is very clear from the research on CCBHC’s that multidisciplinary integrated care works best for clients.  These are diagnoses that can be approached from multiple angles for better care.  Research has also made it very clear that childhood trauma is at the root of some of these diagnoses such as eating disorders.  Without treating the root, it is very difficult to help people heal.
My question is that if behavioral health agencies cannot bill to treat post-partum depression, who treats the mental health part of postpartum depression.    Postpartum depression has at least 1 mental health symptom, depression. If Behavioral Health does not treat postpartum depression, who treats it? The physician? The physician is not trained to treat a mental health disorder.
The other one that stands out to me is eating disorders.  Eating disorders are often related to trauma and have multiple mental health symptoms.  If behavioral health does not treat eating disorders, who does treat this? The physician?  They are not trained to treat mental health disorders.  This is also a diagnosis where coordination between the physician and the mental health therapist is essential.  There is not systemic means for mental health professionals to coordinate with physicians here in Maryland.
What this comes back to is coordinated care for better outcomes instead of the silos of the past.
I have one other issue to raise.  Registered Psychology Associates are allowed to refer clients to PRP. I have verified this through Optum’s staff.  However, that credential is not on the drop-down menus allowing for those credentialed in this way to refer clients to PRP. We have reported this to Optium, as well. I supervise a registered Psychology Associate and I review and used to sign for all referrals she makes to PRP, but when she put me as a co-signer on the referral, she was told that I cannot refer to myself.  That makes no sense and has been partially corrected.  It is still not in the drop-down menu.

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drkathy

I am a psychologist and I own 6 mental health clinics in Maryland, ESPSMD.com. We specialize in working with troubled youth and their families. I have written 2 books and 1 assessment about youth violence and I lecture internationally on bullying and youth and family violence.

2 thoughts on “Copy of a Letter of Inquiry on Disallowed Mental Health Diagnoses”

  1. Hello Dr. Kathy,
    I’m a therapist in California. I am disturbed to hear that postpartum depression is not being covered by insurance. I’m wondering if they cover postpartum psychosis.
    It is very odd to me that they would not cover a disorder that is common and can lead to child abuse and suicide. I wonder if it does have to do with the fact that postpartum is a women’s health issue. There is a group called Postpartum Support International, an advocacy group for those suffering with postpartum, perhaps they can help you.

    1. Dear Laura: Thanks for commenting. I will contact the Post Partum Support international. I was so shocked when I saw the list of disallowed diagnoses. And this is Medicaid we are talking about. It is terrible in my mind to deny poor women treatment for Post partum depression. Interestingly, I have written to BHA about it with no response. Kathy

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