Letters to the Editor - June 5, 2006

Part D exception form won't work with insurers who act in bad faith - Low pay for mental health treatment is a major Medicare shortcoming - Dump United's $1.6 billion CEO

Part D exception form won't work with insurers who act in bad faith

Regarding "Doctors get new tool to cut Part D hassles" (Article, May 1): For our patients, staying on a medicine that may have served them well for years is about drug safety and efficacy. For the Medicare Part D insurance company it's all about money. Your article points out that March 31 marked the end of a period during which plans were required to cover enrollees' drugs even if the medications were not on their covered list.

I received a lot of hassle and denials from the plans during that pre-March 31 period, and none of the medicines which I requested were approved. What makes AMNews think that adding a new form to fill out is going to make the Part D insurance companies any more likely to approve drugs that are not on their formulary? They had no shame in denying them before March 31, when it was required that they must provide them.

In regard to the five levels of appeal, even a semi-retired physician like myself doesn't have the time to go through that entire process, let alone a busy young doctor. The Plan D insurance companies know that.

--Melvin H. Kirschner, MD, MPH, Van Nuys, Calif.

Low pay for mental health treatment is a major Medicare shortcoming

Regarding "Medicare pay formula: Overhaul is needed" (Editorial, Feb. 27): I was distressed that your editorial did not cite the glaring discrimination in Medicare reimbursement that cries out for remediation. I am referring to the lack of parity in payment for mental health claims.

They are paid only 50% of the allowed amount, causing seniors to forgo access to care. While JAMA's 2003 theme issue was on depression, confirming its commonality, severity and costs as one of the most disabling disorders facing the nation, it seems that this is easily forgotten.

Several studies have subsequently been published that show depression's link with cardiovascular morbidity and mortality.

It seems imperative to offer psychiatric help to all on an equal footing with other acute and chronic diseases.

--Cassandra M. Klyman, MD, Bloomfield Hills, Mich.

Dump United's $1.6 billion CEO

Regarding "AMA survey: Health plan market domination virtually complete" (Article, May 8): I was horrified and disgusted when I learned that William McGuire, MD, is getting $1.6 billion in stock options from United HealthGroup, where he is CEO and chair. This at a time when my patients are routinely being denied needed services because of "cost containment."

I can think of a great way to save some money: Fire Dr. McGuire.

Dr. McGuire, shame on you. I hope that you never enjoy a day of your blood money.

--Allison Zibelli, MD, Philadelphia