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Class Says Insurer Won’t Cover Psychotherapy

SEATTLE (CN) - In a class action, psychotherapists claim an insurer uses secret guidelines based on "inadequate data, vague impressions or biases" to deny mental health coverage to people in Washington state.

Lead plaintiff Karen Hansen sued Group Health Collective in King County Court on Monday, alleging deceptive business practices and violations of state law.

Hansen, a licensed independent clinical social worker, says psychotherapy can help the more than 1 million Washington adults with mental illness, at least 200,000 of whom have contemplated suicide.

Washington's Mental Health Parity Act in 2006 guarantees mental health coverage to anyone with medical insurance. It states that mental health care need not be curative to be medically necessary, that treating symptoms of mental illness is enough.

Yet fewer than half of Washington residents with mental illness get the care they need, Hansen says. And she says Group Health's deceptive practices are one reason for that.

Group Health in 2007 adopted "Milliman Care Guidelines" as its criteria for approving psychotherapy, according to the complaint. But Hansen says the company refuses to divulge the guidelines its uses to approve or reject coverage. It divulges its criteria only in "limited and unhelpful ways," such as portions of the guidelines it used to deny coverage.

An Internet search for Milliman Care Guidelines on Wednesday led to password-protected sites for members only, and to a 5-year-old press release touting the guidelines.

Hansen says in the complaint that Group Health claims it won't publish its guidelines because they are proprietary, but Hansen says the secrecy shields the guidelines from necessary peer review

She says the guidelines "were prepared using inadequate data, vague impressions, or biases rather than comprehensive data concerning all psychotherapy techniques by which psychotherapists can provide reasonable and medically necessary psychotherapy."

The guidelines promote short-term therapy techniques over long-term techniques even when more sessions of therapy are medically necessary, Hansen says.

She likened the need for long-term therapy to a diabetic's need for long-term insulin, and asked whether Group Health would limit a 10-hour surgery to just five hours.

She seeks declaratory judgment, treble damages and costs of suit.

She is represented by Albert Kirby with Sound Justice Law Group, who was not immediately available for comment Tuesday.

Group Health did not return a phone call requesting comment.

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