RCPA - Rehabilitation and Community Providers Association


Psychiatrists File Suit against Green Spring and Highmark
June 10, 1999

The Pennsylvania Psychiatric Society, concerned that corporate policies and procedures are affecting mental health treatment, filed suit against Green Spring Health Services and Highmark, Inc. on May 21. Also named in the suit are Magellan Health Services (Green Spring's parent corporation), Keystone Health Plan West, Keystone Health Plan Central, and Keystone Health Plan East.

The suit was filed in the Allegheny County Court of Common Pleas, and cites denials of medically necessary care, misrepresentation by Green Spring and Highmark of the type and quality of services for subscribers, and bureaucratic obstacles to obtaining appropriate treatment. Persons who are aware of similar actions by Green Spring or Highmark are asked to contact Ray Webb or Lu Conser at the PCPA office.

A copy of the Pennsylvania Psychiatric Society's media release is provided below.

Harrisburg (May 21) - Concerned that problems and procedures are affecting the mental health treatment needs of their patients, the Pennsylvania Psychiatric Society today filed a lawsuit against Green Spring Health Services and Highmark, Inc.

Also named in the suit are Magellan Health Services, Inc., Keystone Health Plan West, Keystone Health Plan Central and Keystone Health Plan East.

Green Spring, a subsidiary of Magellan, is the company which administers mental and behavioral health benefits for Highmark. The lawsuit was filed in the Court of Common Pleas of Allegheny County.

The Psychiatric Society, which has filed the suit on behalf of its members and their patients, is asking for changes in the way Green Spring and Highmark determine everything from who can offer psychiatric services to Highmark customers, to how patients are treated.

"We're talking here about insured patients - people who need medical help for treatable illnesses, help they expect to receive under their health care plans," said Philip Lebowitz, a Philadelphia attorney representing the Psychiatric Society. "They are being shortchanged, and the Psychiatric Society has decided to do something about it."

In the suit, the psychiatrists allege:

  • Green Spring and Highmark misrepresent the type and quality of psychiatric services available to their subscribers,
  • Patients are denied authorization from Green Spring and Highmark for the proper amount of inpatient treatment that is necessary for their conditions. The suit includes examples of cases where patients attempted suicide after early release, when authorization for additional treatment had been denied.
  • Patients are discouraged from using mental and behavioral health benefits by the limited number of physicians available in their networks.
  • Appropriately qualified physicians are discouraged from becoming Green Spring providers by requirements of excessive paperwork and a cumbersome approval process that must be used even in emergency circumstances.
  • Green Spring breaches their agreements with psychiatrists in several ways, including not authorizing treatment consistent with the medical standard, and terminating doctors from the provider network without notice.

"Although managed care plans by definition involve some oversight and monitoring of patient care," Lebowitz said, "this lawsuit details incidents and procedures that go beyond what is advisable in serving the mental and behavioral health needs of subscribers.

"The sheer number and scope of roadblocks placed by Green Spring and Highmark in the path of the psychiatrist-patient relationship reflects a consistent pattern that suppresses the use of psychiatric services and that is the basis of the lawsuit."

One incident outlined in the complaint involves a Green Spring employee who contacted a subscriber directly, stating that the employee would be the subscriber's "friend." The employee then met with and questioned the subscriber about the services being provided by the subscriber's psychiatrist. The complaint alleges that this conduct represents a severe intrusion into the physician-patient relationship, that it is improper, and that it could have a serious impact on the effectiveness of the treatment given the patient.

Before filing the lawsuit, Society members met with Highmark and Green Spring officials to try to resolve their concerns. When those discussions were not successful, the Society filed the lawsuit, seeking a ruling that the managed care companies' conduct is improper.

The Pennsylvania Psychiatric Society is a statewide organization representing more than 1,800 physicians practicing the medical specialty of psychiatry, and is affiliated with the American Psychiatric Association. Contact: Gwen Lehman, Executive Director, Pennsylvania Psychiatric Society, (717) 558-7750.

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