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Panel set to hear coverage complaints
By Elizabeth Stawicki
Minnesota Public Radio
January 2, 2002

Beginning Jan. 8, an unusual appeals panel sets up shop in Minnesota. It will be the first of its kind in the country. The panel, comprised of three former Twin Cities judges, will act as an appeals court when health insurer Blue Cross Blue Shield denies mental health coverage to its subscribers.

The so-called, fast-track appeals committee was the cornerstone of a settlement last June between Blue Cross and the state of Minnesota. The state filed suit against the insurance carrier in October 2000, accusing it of systematically delaying and denying mental health coverage to subscribers like Bruce and Mary Campell of Worthington.

The Campbells tried to obtain long-term intensive treatment for their daughter, who was gravely ill from anorexia. Mary Campbell says the couple ended up paying $80,000 dollars out of their own pockets to obtain treatment for their daughter.

"We look back and wish we could've had a little sooner and a bit more initially so we didn't have to go on this long journey. But I guess everybody's learned a lot through it and we're thankful she's still here with us," Mary Campbell says.

Chief Deputy Attorney General Alan Gilbert says forming the appeals committee was so important, the state probably wouldn't have settled its case against Blue Cross without it.

Under the agreement, three Twin Cities judges will automatically review any case in which the health insurer denies mental health coverage to a subscriber. That means people like the Campbells will have to wait only one business day for an answer on their appeal. Gilbert says the independent panel provides a mechanism for subscribers to make sure denials for mental health treatment are reviewed quickly and fairly.

"When it comes to requests for mental health treatment, that if they're denied their request for treatment, there will be this process, and to the extent that a decision is made whether to affirm or reverse the denial, I think consumers can have a comfort level that at least they've been treated fairly and in an expeditious manner," he says.

The judges are former Ramsey County Chief Judge Lawrence Cohen; former Ramsey County Judge Charles Flinn and former Hennepin County Judge Roberta Levy.

Blue Cross Blue Shield Deputy General Counsel Judith Walker welcomes the panel's oversight. She says it will add a level of fairness and impartiality.

"We're very pleased how this has turned out. When it was first contemplated, it wasn't designed with that it would end up being judges. We're really pleased with that. It brings a very high level of credibility to the process and it's hopefully a way for us to continue to learn and continue to improve overall," Walker says.

For her part Mary Campbell is cautiously optimistic. "It will be interesting to see if this works or not but it's a better plan than what we've had in the past. I feel it's going to be a better process. I haven't been through the process but it would've helped back then to have had it," Campbell says.

Blue Cross acknowledges it's not denying mental health coverage at the rate it was before the settlement. The organization says it's evaluated its procedures and is making improvements. The attorney general's office says the reduction in denials is due in part because the health insurer is covering court ordered treatment instead of shifting some of the cost to taxpayers as in the past.

Blue Cross is one of the state's three largest health insurers. Health Partners has also agreed to participate in the panel and the attorney general's office anticipates an agreement with Medica in the not-too-distant future.

More from MPR
  • Blue Cross Blue Shield agrees to cover mental health costs June 19, 2001
  • Managing Managed Care An MPR series from October, 2001.