Tag Archives: Mental

AJMC Session Traces Evolution of ACO Growth, Mental Health Delivery Models


PLAINSBORO, N.J. (PRWEB) December 17, 2014

Accountable care organizations (ACOs), created by the Affordable Care Act to tie payment to the quality of care, go through distinct phases from their formation until they can deliver the “triple aim” of population health, patient satisfaction, and savings.

Applying the lessons of the triple aim to oncology care and bringing better delivery models to mental health care were also on the agenda at the recent WebEx session for the ACO and Emerging Healthcare Delivery Coalition, an initiative of The American Journal of Managed Care.

Better Models for Mental Health Delivery

Lori Raney, MD, of Collaborative Care Consulting, addressed how behavioral health is finding its way into quality measures. While depression screening may be the only measure included in the 33 ACO measures from CMS, other behavioral health metrics exist. It is slowly being realized that in healthcare, a segmented approach to mental health makes little sense medically, and patients whose needs go unaddressed end up driving up costs elsewhere in the form of visits to the emergency department and other high-cost interventions. Nevertheless, most ACOs are still providing behavioral health services in a separate setting, she said.

Models used to integrate behavioral health services into primary care fall along a continuum, Dr. Raney explained.


    Psychiatrists may act as consultants to a practice; they are paid for a few hours a week and do not see patients directly, but discuss cases with the primary care physician (PCP).
    Behavioral health services may co-locate within the same physical space as the PCP.
    Fully embedded services place the psychiatrist or other behavioral health specialist within the PCP practice, providing both consultations and in some cases, one-on-one appointments, depending on the nature of the arrangement.
    In reverse integration, basic treatment of chronic diseases, such as diabetes or cardiovascular disease, is provided to patients with serious mental health problems in the psychiatrist’s office.

Dr. Raney specifically discussed the value of collaborative care, an embedded service model that increases the likelihood that patients will receive the right care and be on the right medication. The TEAMCare approach, pioneered by the University of Washington, was found to save $ 600 to $ 1100 per patient, and has led to better outcomes in both depression scores and cardiometabolic results.

Evolution of ACO Growth

This session covered the distinct steps of ACO evolution. Dave Escalante, senior vice president for OneKey and Marketing, identified four distinct phases of integrated health system growth:

    Expansion of services, which involve acquisitions and direct employment of physicians.
    Health information technology (HIT) upgrades, which create the ability to track and measure progress.
    Standardization of care, which focus on cost-effectiveness through the use of metrics, as well as protocols and pathways.
    Quality outcomes and cost reduction, as ACOs form, the most sophisticated groups assume financial risk for episodes of care.

Escalante said the direct employment of physicians, in contrast with affiliate relationships, was a “critical variable” in the ability of the ACO to achieve triple aim. “The networks that employ physicians seem to be operating at a much more efficient rate, and are evolving through that maturity spectrum at a much quicker rate than those institutions that choose a traditional affiliate relationship,” he said.

Oncology Delivery

Ira Klein, MD, MBA, FACP, of Aetna, discussed how the insurer has developed an oncology delivery model that employs value-based principles within an ACO framework. The arrival of value-based principles has been essential, he said, to uncover the $ 800 million of waste in the system and redeploy it to deliver better care. By developing and testing hypotheses, he said, Aetna has been able to identify five steps for making this transition: modeling, development of clinical analytics, value creation planning, delivery, and ongoing collaboration.

“Getting the metrics right is really difficult,” in developing value-based programs in oncology, Dr. Klein said. It’s taken Aetna almost four years, although the insurer believes it now has the model correct. Once it’s all up and running, however, payers and practices get data that allow them to make changes in the short-term. “You get a better system. Patients like it better. Outcomes are better. Providers like it better,” he said. “Technology acts as the lubricant to make it easy.”

About the ACO Coalition

As ACOs and other emerging delivery and payment models evolve and move away from traditional fee-for-service system models toward cost-effective and value-based care, the need to understand how these models will evolve is critical to building long-term strategic solutions. The mission of the ACO Coalition is to bring together a diverse group of key stakeholders, including ACO providers and leaders, payers, IDNs, specialty pharmacy, and pharmaceutical manufacturers to work collaboratively to build value and improve the quality and overall outcomes of patient care. Coalition members share ideas and best practices through live meetings, Web-based interactive sessions, and conference calls. Distinguishing features are the Coalition’s access to leading experts and its small workshops that allow creative problem-solving. To learn more, click here.

CONTACT:    

Nicole Beagin (609) 716-7777 x 131

nbeagin(at)ajmc(dot)com

http://www.ajmc.com







AJMC Session Traces Evolution of ACO Growth, Mental Health Delivery Models


PLAINSBORO, N.J. (PRWEB) December 17, 2014

Accountable care organizations (ACOs), created by the Affordable Care Act to tie payment to the quality of care, go through distinct phases from their formation until they can deliver the “triple aim” of population health, patient satisfaction, and savings.

Applying the lessons of the triple aim to oncology care and bringing better delivery models to mental health care were also on the agenda at the recent WebEx session for the ACO and Emerging Healthcare Delivery Coalition, an initiative of The American Journal of Managed Care.

Better Models for Mental Health Delivery

Lori Raney, MD, of Collaborative Care Consulting, addressed how behavioral health is finding its way into quality measures. While depression screening may be the only measure included in the 33 ACO measures from CMS, other behavioral health metrics exist. It is slowly being realized that in healthcare, a segmented approach to mental health makes little sense medically, and patients whose needs go unaddressed end up driving up costs elsewhere in the form of visits to the emergency department and other high-cost interventions. Nevertheless, most ACOs are still providing behavioral health services in a separate setting, she said.

Models used to integrate behavioral health services into primary care fall along a continuum, Dr. Raney explained.


    Psychiatrists may act as consultants to a practice; they are paid for a few hours a week and do not see patients directly, but discuss cases with the primary care physician (PCP).
    Behavioral health services may co-locate within the same physical space as the PCP.
    Fully embedded services place the psychiatrist or other behavioral health specialist within the PCP practice, providing both consultations and in some cases, one-on-one appointments, depending on the nature of the arrangement.
    In reverse integration, basic treatment of chronic diseases, such as diabetes or cardiovascular disease, is provided to patients with serious mental health problems in the psychiatrist’s office.

Dr. Raney specifically discussed the value of collaborative care, an embedded service model that increases the likelihood that patients will receive the right care and be on the right medication. The TEAMCare approach, pioneered by the University of Washington, was found to save $ 600 to $ 1100 per patient, and has led to better outcomes in both depression scores and cardiometabolic results.

Evolution of ACO Growth

This session covered the distinct steps of ACO evolution. Dave Escalante, senior vice president for OneKey and Marketing, identified four distinct phases of integrated health system growth:

    Expansion of services, which involve acquisitions and direct employment of physicians.
    Health information technology (HIT) upgrades, which create the ability to track and measure progress.
    Standardization of care, which focus on cost-effectiveness through the use of metrics, as well as protocols and pathways.
    Quality outcomes and cost reduction, as ACOs form, the most sophisticated groups assume financial risk for episodes of care.

Escalante said the direct employment of physicians, in contrast with affiliate relationships, was a “critical variable” in the ability of the ACO to achieve triple aim. “The networks that employ physicians seem to be operating at a much more efficient rate, and are evolving through that maturity spectrum at a much quicker rate than those institutions that choose a traditional affiliate relationship,” he said.

Oncology Delivery

Ira Klein, MD, MBA, FACP, of Aetna, discussed how the insurer has developed an oncology delivery model that employs value-based principles within an ACO framework. The arrival of value-based principles has been essential, he said, to uncover the $ 800 million of waste in the system and redeploy it to deliver better care. By developing and testing hypotheses, he said, Aetna has been able to identify five steps for making this transition: modeling, development of clinical analytics, value creation planning, delivery, and ongoing collaboration.

“Getting the metrics right is really difficult,” in developing value-based programs in oncology, Dr. Klein said. It’s taken Aetna almost four years, although the insurer believes it now has the model correct. Once it’s all up and running, however, payers and practices get data that allow them to make changes in the short-term. “You get a better system. Patients like it better. Outcomes are better. Providers like it better,” he said. “Technology acts as the lubricant to make it easy.”

About the ACO Coalition

As ACOs and other emerging delivery and payment models evolve and move away from traditional fee-for-service system models toward cost-effective and value-based care, the need to understand how these models will evolve is critical to building long-term strategic solutions. The mission of the ACO Coalition is to bring together a diverse group of key stakeholders, including ACO providers and leaders, payers, IDNs, specialty pharmacy, and pharmaceutical manufacturers to work collaboratively to build value and improve the quality and overall outcomes of patient care. Coalition members share ideas and best practices through live meetings, Web-based interactive sessions, and conference calls. Distinguishing features are the Coalition’s access to leading experts and its small workshops that allow creative problem-solving. To learn more, click here.

CONTACT:    

Nicole Beagin (609) 716-7777 x 131

nbeagin(at)ajmc(dot)com

http://www.ajmc.com







AJMC Session Traces Evolution of ACO Growth, Mental Health Delivery Models


PLAINSBORO, N.J. (PRWEB) December 17, 2014

Accountable care organizations (ACOs), created by the Affordable Care Act to tie payment to the quality of care, go through distinct phases from their formation until they can deliver the “triple aim” of population health, patient satisfaction, and savings.

Applying the lessons of the triple aim to oncology care and bringing better delivery models to mental health care were also on the agenda at the recent WebEx session for the ACO and Emerging Healthcare Delivery Coalition, an initiative of The American Journal of Managed Care.

Better Models for Mental Health Delivery

Lori Raney, MD, of Collaborative Care Consulting, addressed how behavioral health is finding its way into quality measures. While depression screening may be the only measure included in the 33 ACO measures from CMS, other behavioral health metrics exist. It is slowly being realized that in healthcare, a segmented approach to mental health makes little sense medically, and patients whose needs go unaddressed end up driving up costs elsewhere in the form of visits to the emergency department and other high-cost interventions. Nevertheless, most ACOs are still providing behavioral health services in a separate setting, she said.

Models used to integrate behavioral health services into primary care fall along a continuum, Dr. Raney explained.


    Psychiatrists may act as consultants to a practice; they are paid for a few hours a week and do not see patients directly, but discuss cases with the primary care physician (PCP).
    Behavioral health services may co-locate within the same physical space as the PCP.
    Fully embedded services place the psychiatrist or other behavioral health specialist within the PCP practice, providing both consultations and in some cases, one-on-one appointments, depending on the nature of the arrangement.
    In reverse integration, basic treatment of chronic diseases, such as diabetes or cardiovascular disease, is provided to patients with serious mental health problems in the psychiatrist’s office.

Dr. Raney specifically discussed the value of collaborative care, an embedded service model that increases the likelihood that patients will receive the right care and be on the right medication. The TEAMCare approach, pioneered by the University of Washington, was found to save $ 600 to $ 1100 per patient, and has led to better outcomes in both depression scores and cardiometabolic results.

Evolution of ACO Growth

This session covered the distinct steps of ACO evolution. Dave Escalante, senior vice president for OneKey and Marketing, identified four distinct phases of integrated health system growth:

    Expansion of services, which involve acquisitions and direct employment of physicians.
    Health information technology (HIT) upgrades, which create the ability to track and measure progress.
    Standardization of care, which focus on cost-effectiveness through the use of metrics, as well as protocols and pathways.
    Quality outcomes and cost reduction, as ACOs form, the most sophisticated groups assume financial risk for episodes of care.

Escalante said the direct employment of physicians, in contrast with affiliate relationships, was a “critical variable” in the ability of the ACO to achieve triple aim. “The networks that employ physicians seem to be operating at a much more efficient rate, and are evolving through that maturity spectrum at a much quicker rate than those institutions that choose a traditional affiliate relationship,” he said.

Oncology Delivery

Ira Klein, MD, MBA, FACP, of Aetna, discussed how the insurer has developed an oncology delivery model that employs value-based principles within an ACO framework. The arrival of value-based principles has been essential, he said, to uncover the $ 800 million of waste in the system and redeploy it to deliver better care. By developing and testing hypotheses, he said, Aetna has been able to identify five steps for making this transition: modeling, development of clinical analytics, value creation planning, delivery, and ongoing collaboration.

“Getting the metrics right is really difficult,” in developing value-based programs in oncology, Dr. Klein said. It’s taken Aetna almost four years, although the insurer believes it now has the model correct. Once it’s all up and running, however, payers and practices get data that allow them to make changes in the short-term. “You get a better system. Patients like it better. Outcomes are better. Providers like it better,” he said. “Technology acts as the lubricant to make it easy.”

About the ACO Coalition

As ACOs and other emerging delivery and payment models evolve and move away from traditional fee-for-service system models toward cost-effective and value-based care, the need to understand how these models will evolve is critical to building long-term strategic solutions. The mission of the ACO Coalition is to bring together a diverse group of key stakeholders, including ACO providers and leaders, payers, IDNs, specialty pharmacy, and pharmaceutical manufacturers to work collaboratively to build value and improve the quality and overall outcomes of patient care. Coalition members share ideas and best practices through live meetings, Web-based interactive sessions, and conference calls. Distinguishing features are the Coalition’s access to leading experts and its small workshops that allow creative problem-solving. To learn more, click here.

CONTACT:    

Nicole Beagin (609) 716-7777 x 131

nbeagin(at)ajmc(dot)com

http://www.ajmc.com







AJMC Session Traces Evolution of ACO Growth, Mental Health Delivery Models


PLAINSBORO, N.J. (PRWEB) December 17, 2014

Accountable care organizations (ACOs), created by the Affordable Care Act to tie payment to the quality of care, go through distinct phases from their formation until they can deliver the “triple aim” of population health, patient satisfaction, and savings.

Applying the lessons of the triple aim to oncology care and bringing better delivery models to mental health care were also on the agenda at the recent WebEx session for the ACO and Emerging Healthcare Delivery Coalition, an initiative of The American Journal of Managed Care.

Better Models for Mental Health Delivery

Lori Raney, MD, of Collaborative Care Consulting, addressed how behavioral health is finding its way into quality measures. While depression screening may be the only measure included in the 33 ACO measures from CMS, other behavioral health metrics exist. It is slowly being realized that in healthcare, a segmented approach to mental health makes little sense medically, and patients whose needs go unaddressed end up driving up costs elsewhere in the form of visits to the emergency department and other high-cost interventions. Nevertheless, most ACOs are still providing behavioral health services in a separate setting, she said.

Models used to integrate behavioral health services into primary care fall along a continuum, Dr. Raney explained.


    Psychiatrists may act as consultants to a practice; they are paid for a few hours a week and do not see patients directly, but discuss cases with the primary care physician (PCP).
    Behavioral health services may co-locate within the same physical space as the PCP.
    Fully embedded services place the psychiatrist or other behavioral health specialist within the PCP practice, providing both consultations and in some cases, one-on-one appointments, depending on the nature of the arrangement.
    In reverse integration, basic treatment of chronic diseases, such as diabetes or cardiovascular disease, is provided to patients with serious mental health problems in the psychiatrist’s office.

Dr. Raney specifically discussed the value of collaborative care, an embedded service model that increases the likelihood that patients will receive the right care and be on the right medication. The TEAMCare approach, pioneered by the University of Washington, was found to save $ 600 to $ 1100 per patient, and has led to better outcomes in both depression scores and cardiometabolic results.

Evolution of ACO Growth

This session covered the distinct steps of ACO evolution. Dave Escalante, senior vice president for OneKey and Marketing, identified four distinct phases of integrated health system growth:

    Expansion of services, which involve acquisitions and direct employment of physicians.
    Health information technology (HIT) upgrades, which create the ability to track and measure progress.
    Standardization of care, which focus on cost-effectiveness through the use of metrics, as well as protocols and pathways.
    Quality outcomes and cost reduction, as ACOs form, the most sophisticated groups assume financial risk for episodes of care.

Escalante said the direct employment of physicians, in contrast with affiliate relationships, was a “critical variable” in the ability of the ACO to achieve triple aim. “The networks that employ physicians seem to be operating at a much more efficient rate, and are evolving through that maturity spectrum at a much quicker rate than those institutions that choose a traditional affiliate relationship,” he said.

Oncology Delivery

Ira Klein, MD, MBA, FACP, of Aetna, discussed how the insurer has developed an oncology delivery model that employs value-based principles within an ACO framework. The arrival of value-based principles has been essential, he said, to uncover the $ 800 million of waste in the system and redeploy it to deliver better care. By developing and testing hypotheses, he said, Aetna has been able to identify five steps for making this transition: modeling, development of clinical analytics, value creation planning, delivery, and ongoing collaboration.

“Getting the metrics right is really difficult,” in developing value-based programs in oncology, Dr. Klein said. It’s taken Aetna almost four years, although the insurer believes it now has the model correct. Once it’s all up and running, however, payers and practices get data that allow them to make changes in the short-term. “You get a better system. Patients like it better. Outcomes are better. Providers like it better,” he said. “Technology acts as the lubricant to make it easy.”

About the ACO Coalition

As ACOs and other emerging delivery and payment models evolve and move away from traditional fee-for-service system models toward cost-effective and value-based care, the need to understand how these models will evolve is critical to building long-term strategic solutions. The mission of the ACO Coalition is to bring together a diverse group of key stakeholders, including ACO providers and leaders, payers, IDNs, specialty pharmacy, and pharmaceutical manufacturers to work collaboratively to build value and improve the quality and overall outcomes of patient care. Coalition members share ideas and best practices through live meetings, Web-based interactive sessions, and conference calls. Distinguishing features are the Coalition’s access to leading experts and its small workshops that allow creative problem-solving. To learn more, click here.

CONTACT:    

Nicole Beagin (609) 716-7777 x 131

nbeagin(at)ajmc(dot)com

http://www.ajmc.com







AJMC Session Traces Evolution of ACO Growth, Mental Health Delivery Models


PLAINSBORO, N.J. (PRWEB) December 17, 2014

Accountable care organizations (ACOs), created by the Affordable Care Act to tie payment to the quality of care, go through distinct phases from their formation until they can deliver the “triple aim” of population health, patient satisfaction, and savings.

Applying the lessons of the triple aim to oncology care and bringing better delivery models to mental health care were also on the agenda at the recent WebEx session for the ACO and Emerging Healthcare Delivery Coalition, an initiative of The American Journal of Managed Care.

Better Models for Mental Health Delivery

Lori Raney, MD, of Collaborative Care Consulting, addressed how behavioral health is finding its way into quality measures. While depression screening may be the only measure included in the 33 ACO measures from CMS, other behavioral health metrics exist. It is slowly being realized that in healthcare, a segmented approach to mental health makes little sense medically, and patients whose needs go unaddressed end up driving up costs elsewhere in the form of visits to the emergency department and other high-cost interventions. Nevertheless, most ACOs are still providing behavioral health services in a separate setting, she said.

Models used to integrate behavioral health services into primary care fall along a continuum, Dr. Raney explained.


    Psychiatrists may act as consultants to a practice; they are paid for a few hours a week and do not see patients directly, but discuss cases with the primary care physician (PCP).
    Behavioral health services may co-locate within the same physical space as the PCP.
    Fully embedded services place the psychiatrist or other behavioral health specialist within the PCP practice, providing both consultations and in some cases, one-on-one appointments, depending on the nature of the arrangement.
    In reverse integration, basic treatment of chronic diseases, such as diabetes or cardiovascular disease, is provided to patients with serious mental health problems in the psychiatrist’s office.

Dr. Raney specifically discussed the value of collaborative care, an embedded service model that increases the likelihood that patients will receive the right care and be on the right medication. The TEAMCare approach, pioneered by the University of Washington, was found to save $ 600 to $ 1100 per patient, and has led to better outcomes in both depression scores and cardiometabolic results.

Evolution of ACO Growth

This session covered the distinct steps of ACO evolution. Dave Escalante, senior vice president for OneKey and Marketing, identified four distinct phases of integrated health system growth:

    Expansion of services, which involve acquisitions and direct employment of physicians.
    Health information technology (HIT) upgrades, which create the ability to track and measure progress.
    Standardization of care, which focus on cost-effectiveness through the use of metrics, as well as protocols and pathways.
    Quality outcomes and cost reduction, as ACOs form, the most sophisticated groups assume financial risk for episodes of care.

Escalante said the direct employment of physicians, in contrast with affiliate relationships, was a “critical variable” in the ability of the ACO to achieve triple aim. “The networks that employ physicians seem to be operating at a much more efficient rate, and are evolving through that maturity spectrum at a much quicker rate than those institutions that choose a traditional affiliate relationship,” he said.

Oncology Delivery

Ira Klein, MD, MBA, FACP, of Aetna, discussed how the insurer has developed an oncology delivery model that employs value-based principles within an ACO framework. The arrival of value-based principles has been essential, he said, to uncover the $ 800 million of waste in the system and redeploy it to deliver better care. By developing and testing hypotheses, he said, Aetna has been able to identify five steps for making this transition: modeling, development of clinical analytics, value creation planning, delivery, and ongoing collaboration.

“Getting the metrics right is really difficult,” in developing value-based programs in oncology, Dr. Klein said. It’s taken Aetna almost four years, although the insurer believes it now has the model correct. Once it’s all up and running, however, payers and practices get data that allow them to make changes in the short-term. “You get a better system. Patients like it better. Outcomes are better. Providers like it better,” he said. “Technology acts as the lubricant to make it easy.”

About the ACO Coalition

As ACOs and other emerging delivery and payment models evolve and move away from traditional fee-for-service system models toward cost-effective and value-based care, the need to understand how these models will evolve is critical to building long-term strategic solutions. The mission of the ACO Coalition is to bring together a diverse group of key stakeholders, including ACO providers and leaders, payers, IDNs, specialty pharmacy, and pharmaceutical manufacturers to work collaboratively to build value and improve the quality and overall outcomes of patient care. Coalition members share ideas and best practices through live meetings, Web-based interactive sessions, and conference calls. Distinguishing features are the Coalition’s access to leading experts and its small workshops that allow creative problem-solving. To learn more, click here.

CONTACT:    

Nicole Beagin (609) 716-7777 x 131

nbeagin(at)ajmc(dot)com

http://www.ajmc.com







CBS’ 60 Minutes Segment, Denied, Highlights Medical Treatment for Patients with Mental Illness, says Leading Expert, Lisa S. Kantor of Kantor Law


North Ridge, CA (PRWEB) December 16, 2014

The 60 Minutes segment “Denied” highlights that insurance companies deny medically necessary treatment for patients with mental illnesses. According to 60 Minutes, “we found that the vast majority of claims are routine but the insurance industry aggressively reviews the cost of chronic cases. Long-term care is often denied by insurance company doctors who never see the patient. As a result, some seriously ill patients are discharged from hospitals over the objections of psychiatrists who warn that someone may die. (CBS News, 60 Minutes, Denied, December 14, 2014)

The CBS segment states that doctors hired by the insurance company are paid for each medical review they complete. 60 Minutes reveals that many doctors make life and death decisions about what treatment people will get based only on telephone conversations with the treatment team. Stating that these doctors do not even look at medical records and they do not examine or meet the patient.

Lisa S. Kantor, partner at Kantor and Kantor Law and an expert on eating disorders, mental illness and insurance law, is leading the charge with a class action suit filed against Anthem for these exact same reasons. “The treatment team – the psychiatrists, the dieticians and psychologists – are the ones who know what is best for the patient. Historically and to date, the insurance companies and their doctors often send patients home too soon, when they still need supervision and specialized care,” says Kantor.

My experience with medical professionals who treat the mentally ill is that they are brilliant, dedicated people. They have the best interests of their patients in mind and obviously want their patients to get better and get out of treatment, says Kantor.

California Insurance Commissioner Dave Jones weighed in on the 60 Minutes segment, stating that “Medically necessary mental health treatment, including residential mental health treatment, is required to be covered under mental health parity laws. This 60 Minutes feature puts a national spotlight on the all too common practice of denying people with severe mental illness the medical care to which they are entitled.” (CA Dept of Insurance, Insurance Commissioner responds to 60 Minutes story about insurer denials of coverage for mental health treatment, December 15, 2014)

Together with Kathryn Trepinski, Lisa Kantor filed this class action against Anthem, in an attempt to highlight Anthem’s corporate practices and the use of doctors who approve the denial of coverage 92% – 100% of the time. According to the CBS 60 Minutes segment, Dr. Timothy Jack’s denial rate averaged 92 percent in one six month period in 2011, yet that was typical among 11 reviewers contracted by Anthem. Some doctors are reported to have denial rates of 95 and 100 percent.

Lisa S. Kantor is available for interviews, contact MPR and ask for Robin 919-745-9333.

For more information on the class action call our offices at 800-446-7529.

Reference: CASE NO.: BC518736, Superior Court of the State of California, for the county of Los Angeles, Central Civil West

About Kantor and Kantor, LLP

Glenn and Lisa Kantor fight on behalf of policyholders who are denied treatment for mental illness by any insurance company. All cases are reviewed and our team is experienced and qualified to help claimants.

Kantor and Kantor is the largest law firm in the country exclusively representing plaintiffs who have been denied insurance benefits from life, health, disability, and long-term care policies. The firm has extensive experience with the complex appeals process and federal court litigation of ERISA matters and files more ERISA cases than any other law firm in California. We do not broker policies, we fight for your rights to get the best possible outcome. For more information, visit us at http://www.KantorLaw.net follow our blog http://www.californiainsurancelawyerblog.com and follow us on Twitter @LisaSKantor.







CBS’ 60 Minutes Segment, Denied, Highlights Medical Treatment for Patients with Mental Illness, says Leading Expert, Lisa S. Kantor of Kantor Law


North Ridge, CA (PRWEB) December 16, 2014

The 60 Minutes segment “Denied” highlights that insurance companies deny medically necessary treatment for patients with mental illnesses. According to 60 Minutes, “we found that the vast majority of claims are routine but the insurance industry aggressively reviews the cost of chronic cases. Long-term care is often denied by insurance company doctors who never see the patient. As a result, some seriously ill patients are discharged from hospitals over the objections of psychiatrists who warn that someone may die. (CBS News, 60 Minutes, Denied, December 14, 2014)

The CBS segment states that doctors hired by the insurance company are paid for each medical review they complete. 60 Minutes reveals that many doctors make life and death decisions about what treatment people will get based only on telephone conversations with the treatment team. Stating that these doctors do not even look at medical records and they do not examine or meet the patient.

Lisa S. Kantor, partner at Kantor and Kantor Law and an expert on eating disorders, mental illness and insurance law, is leading the charge with a class action suit filed against Anthem for these exact same reasons. “The treatment team – the psychiatrists, the dieticians and psychologists – are the ones who know what is best for the patient. Historically and to date, the insurance companies and their doctors often send patients home too soon, when they still need supervision and specialized care,” says Kantor.

My experience with medical professionals who treat the mentally ill is that they are brilliant, dedicated people. They have the best interests of their patients in mind and obviously want their patients to get better and get out of treatment, says Kantor.

California Insurance Commissioner Dave Jones weighed in on the 60 Minutes segment, stating that “Medically necessary mental health treatment, including residential mental health treatment, is required to be covered under mental health parity laws. This 60 Minutes feature puts a national spotlight on the all too common practice of denying people with severe mental illness the medical care to which they are entitled.” (CA Dept of Insurance, Insurance Commissioner responds to 60 Minutes story about insurer denials of coverage for mental health treatment, December 15, 2014)

Together with Kathryn Trepinski, Lisa Kantor filed this class action against Anthem, in an attempt to highlight Anthem’s corporate practices and the use of doctors who approve the denial of coverage 92% – 100% of the time. According to the CBS 60 Minutes segment, Dr. Timothy Jack’s denial rate averaged 92 percent in one six month period in 2011, yet that was typical among 11 reviewers contracted by Anthem. Some doctors are reported to have denial rates of 95 and 100 percent.

Lisa S. Kantor is available for interviews, contact MPR and ask for Robin 919-745-9333.

For more information on the class action call our offices at 800-446-7529.

Reference: CASE NO.: BC518736, Superior Court of the State of California, for the county of Los Angeles, Central Civil West

About Kantor and Kantor, LLP

Glenn and Lisa Kantor fight on behalf of policyholders who are denied treatment for mental illness by any insurance company. All cases are reviewed and our team is experienced and qualified to help claimants.

Kantor and Kantor is the largest law firm in the country exclusively representing plaintiffs who have been denied insurance benefits from life, health, disability, and long-term care policies. The firm has extensive experience with the complex appeals process and federal court litigation of ERISA matters and files more ERISA cases than any other law firm in California. We do not broker policies, we fight for your rights to get the best possible outcome. For more information, visit us at http://www.KantorLaw.net follow our blog http://www.californiainsurancelawyerblog.com and follow us on Twitter @LisaSKantor.







CBS’ 60 Minutes Segment, Denied, Highlights Medical Treatment for Patients with Mental Illness, says Leading Expert, Lisa S. Kantor of Kantor Law


North Ridge, CA (PRWEB) December 16, 2014

The 60 Minutes segment “Denied” highlights that insurance companies deny medically necessary treatment for patients with mental illnesses. According to 60 Minutes, “we found that the vast majority of claims are routine but the insurance industry aggressively reviews the cost of chronic cases. Long-term care is often denied by insurance company doctors who never see the patient. As a result, some seriously ill patients are discharged from hospitals over the objections of psychiatrists who warn that someone may die. (CBS News, 60 Minutes, Denied, December 14, 2014)

The CBS segment states that doctors hired by the insurance company are paid for each medical review they complete. 60 Minutes reveals that many doctors make life and death decisions about what treatment people will get based only on telephone conversations with the treatment team. Stating that these doctors do not even look at medical records and they do not examine or meet the patient.

Lisa S. Kantor, partner at Kantor and Kantor Law and an expert on eating disorders, mental illness and insurance law, is leading the charge with a class action suit filed against Anthem for these exact same reasons. “The treatment team – the psychiatrists, the dieticians and psychologists – are the ones who know what is best for the patient. Historically and to date, the insurance companies and their doctors often send patients home too soon, when they still need supervision and specialized care,” says Kantor.

My experience with medical professionals who treat the mentally ill is that they are brilliant, dedicated people. They have the best interests of their patients in mind and obviously want their patients to get better and get out of treatment, says Kantor.

California Insurance Commissioner Dave Jones weighed in on the 60 Minutes segment, stating that “Medically necessary mental health treatment, including residential mental health treatment, is required to be covered under mental health parity laws. This 60 Minutes feature puts a national spotlight on the all too common practice of denying people with severe mental illness the medical care to which they are entitled.” (CA Dept of Insurance, Insurance Commissioner responds to 60 Minutes story about insurer denials of coverage for mental health treatment, December 15, 2014)

Together with Kathryn Trepinski, Lisa Kantor filed this class action against Anthem, in an attempt to highlight Anthem’s corporate practices and the use of doctors who approve the denial of coverage 92% – 100% of the time. According to the CBS 60 Minutes segment, Dr. Timothy Jack’s denial rate averaged 92 percent in one six month period in 2011, yet that was typical among 11 reviewers contracted by Anthem. Some doctors are reported to have denial rates of 95 and 100 percent.

Lisa S. Kantor is available for interviews, contact MPR and ask for Robin 919-745-9333.

For more information on the class action call our offices at 800-446-7529.

Reference: CASE NO.: BC518736, Superior Court of the State of California, for the county of Los Angeles, Central Civil West

About Kantor and Kantor, LLP

Glenn and Lisa Kantor fight on behalf of policyholders who are denied treatment for mental illness by any insurance company. All cases are reviewed and our team is experienced and qualified to help claimants.

Kantor and Kantor is the largest law firm in the country exclusively representing plaintiffs who have been denied insurance benefits from life, health, disability, and long-term care policies. The firm has extensive experience with the complex appeals process and federal court litigation of ERISA matters and files more ERISA cases than any other law firm in California. We do not broker policies, we fight for your rights to get the best possible outcome. For more information, visit us at http://www.KantorLaw.net follow our blog http://www.californiainsurancelawyerblog.com and follow us on Twitter @LisaSKantor.







CBS’ 60 Minutes Segment, Denied, Highlights Medical Treatment for Patients with Mental Illness, says Leading Expert, Lisa S. Kantor of Kantor Law


North Ridge, CA (PRWEB) December 16, 2014

The 60 Minutes segment “Denied” highlights that insurance companies deny medically necessary treatment for patients with mental illnesses. According to 60 Minutes, “we found that the vast majority of claims are routine but the insurance industry aggressively reviews the cost of chronic cases. Long-term care is often denied by insurance company doctors who never see the patient. As a result, some seriously ill patients are discharged from hospitals over the objections of psychiatrists who warn that someone may die. (CBS News, 60 Minutes, Denied, December 14, 2014)

The CBS segment states that doctors hired by the insurance company are paid for each medical review they complete. 60 Minutes reveals that many doctors make life and death decisions about what treatment people will get based only on telephone conversations with the treatment team. Stating that these doctors do not even look at medical records and they do not examine or meet the patient.

Lisa S. Kantor, partner at Kantor and Kantor Law and an expert on eating disorders, mental illness and insurance law, is leading the charge with a class action suit filed against Anthem for these exact same reasons. “The treatment team – the psychiatrists, the dieticians and psychologists – are the ones who know what is best for the patient. Historically and to date, the insurance companies and their doctors often send patients home too soon, when they still need supervision and specialized care,” says Kantor.

My experience with medical professionals who treat the mentally ill is that they are brilliant, dedicated people. They have the best interests of their patients in mind and obviously want their patients to get better and get out of treatment, says Kantor.

California Insurance Commissioner Dave Jones weighed in on the 60 Minutes segment, stating that “Medically necessary mental health treatment, including residential mental health treatment, is required to be covered under mental health parity laws. This 60 Minutes feature puts a national spotlight on the all too common practice of denying people with severe mental illness the medical care to which they are entitled.” (CA Dept of Insurance, Insurance Commissioner responds to 60 Minutes story about insurer denials of coverage for mental health treatment, December 15, 2014)

Together with Kathryn Trepinski, Lisa Kantor filed this class action against Anthem, in an attempt to highlight Anthem’s corporate practices and the use of doctors who approve the denial of coverage 92% – 100% of the time. According to the CBS 60 Minutes segment, Dr. Timothy Jack’s denial rate averaged 92 percent in one six month period in 2011, yet that was typical among 11 reviewers contracted by Anthem. Some doctors are reported to have denial rates of 95 and 100 percent.

Lisa S. Kantor is available for interviews, contact MPR and ask for Robin 919-745-9333.

For more information on the class action call our offices at 800-446-7529.

Reference: CASE NO.: BC518736, Superior Court of the State of California, for the county of Los Angeles, Central Civil West

About Kantor and Kantor, LLP

Glenn and Lisa Kantor fight on behalf of policyholders who are denied treatment for mental illness by any insurance company. All cases are reviewed and our team is experienced and qualified to help claimants.

Kantor and Kantor is the largest law firm in the country exclusively representing plaintiffs who have been denied insurance benefits from life, health, disability, and long-term care policies. The firm has extensive experience with the complex appeals process and federal court litigation of ERISA matters and files more ERISA cases than any other law firm in California. We do not broker policies, we fight for your rights to get the best possible outcome. For more information, visit us at http://www.KantorLaw.net follow our blog http://www.californiainsurancelawyerblog.com and follow us on Twitter @LisaSKantor.







CBS’ 60 Minutes Segment, Denied, Highlights Medical Treatment for Patients with Mental Illness, says Leading Expert, Lisa S. Kantor of Kantor Law


North Ridge, CA (PRWEB) December 16, 2014

The 60 Minutes segment “Denied” highlights that insurance companies deny medically necessary treatment for patients with mental illnesses. According to 60 Minutes, “we found that the vast majority of claims are routine but the insurance industry aggressively reviews the cost of chronic cases. Long-term care is often denied by insurance company doctors who never see the patient. As a result, some seriously ill patients are discharged from hospitals over the objections of psychiatrists who warn that someone may die. (CBS News, 60 Minutes, Denied, December 14, 2014)

The CBS segment states that doctors hired by the insurance company are paid for each medical review they complete. 60 Minutes reveals that many doctors make life and death decisions about what treatment people will get based only on telephone conversations with the treatment team. Stating that these doctors do not even look at medical records and they do not examine or meet the patient.

Lisa S. Kantor, partner at Kantor and Kantor Law and an expert on eating disorders, mental illness and insurance law, is leading the charge with a class action suit filed against Anthem for these exact same reasons. “The treatment team – the psychiatrists, the dieticians and psychologists – are the ones who know what is best for the patient. Historically and to date, the insurance companies and their doctors often send patients home too soon, when they still need supervision and specialized care,” says Kantor.

My experience with medical professionals who treat the mentally ill is that they are brilliant, dedicated people. They have the best interests of their patients in mind and obviously want their patients to get better and get out of treatment, says Kantor.

California Insurance Commissioner Dave Jones weighed in on the 60 Minutes segment, stating that “Medically necessary mental health treatment, including residential mental health treatment, is required to be covered under mental health parity laws. This 60 Minutes feature puts a national spotlight on the all too common practice of denying people with severe mental illness the medical care to which they are entitled.” (CA Dept of Insurance, Insurance Commissioner responds to 60 Minutes story about insurer denials of coverage for mental health treatment, December 15, 2014)

Together with Kathryn Trepinski, Lisa Kantor filed this class action against Anthem, in an attempt to highlight Anthem’s corporate practices and the use of doctors who approve the denial of coverage 92% – 100% of the time. According to the CBS 60 Minutes segment, Dr. Timothy Jack’s denial rate averaged 92 percent in one six month period in 2011, yet that was typical among 11 reviewers contracted by Anthem. Some doctors are reported to have denial rates of 95 and 100 percent.

Lisa S. Kantor is available for interviews, contact MPR and ask for Robin 919-745-9333.

For more information on the class action call our offices at 800-446-7529.

Reference: CASE NO.: BC518736, Superior Court of the State of California, for the county of Los Angeles, Central Civil West

About Kantor and Kantor, LLP

Glenn and Lisa Kantor fight on behalf of policyholders who are denied treatment for mental illness by any insurance company. All cases are reviewed and our team is experienced and qualified to help claimants.

Kantor and Kantor is the largest law firm in the country exclusively representing plaintiffs who have been denied insurance benefits from life, health, disability, and long-term care policies. The firm has extensive experience with the complex appeals process and federal court litigation of ERISA matters and files more ERISA cases than any other law firm in California. We do not broker policies, we fight for your rights to get the best possible outcome. For more information, visit us at http://www.KantorLaw.net follow our blog http://www.californiainsurancelawyerblog.com and follow us on Twitter @LisaSKantor.