Regarding Dr. Nasrallah’s excellent editorial ("Why are metabolic guidelines being ignored?"; Current Psychiatry, From the Editor, December 2012, p. 4-5; http://bit.ly/1GI2FFY): The next step is to get insurance companies, the Veterans Administration (VA), and the government to recognize that persons with “behavioral” illnesses may need a psychiatrist to identify and treat physical illnesses to comprehensively address—and in some cases, cure—the patient’s behavioral problem.
It is maddening that some insurance companies categorize mental illnesses apart from physical illnesses and will not process nonmental health service codes submitted by psychiatrists. Psychiatrists get chastised by insurance companies, the VA, and the government for ordering too many laboratory tests, as if there were no need for patients with mental illnesses to undergo metabolic monitoring. If the test is not reimbursed, then the test is not ordered. If psychiatrists are demeaned by mainstream medicine for holistically caring for their patients, then it’s no wonder psychiatry is a specialty on its way out.
Charles J. Mertz
Business Manager
Private Practice
Springfield, IL
Dr. Nasrallah responds
I thank Drs. Goldsmith and Vahabzadeh and Mr. Mertz for their letters.
Psychiatrists and nurse practitioners routinely order lab tests for patients as part of a physical assessment before starting any medication, whether at baseline or follow-up. Third-party payers cover complete blood counts, liver function tests, kidney function tests, and other tests. Thus, metabolic monitoring tests—including fasting glucose, fasting triglycerides, and fasting high-density lipoprotein—are no exception.
Any insurer who refuses to reimburse those tests for a patient receiving atypical antipsychotics can be liable in a court of law, especially in light of FDA recommendations.
Henry A. Nasrallah, MDEditor-in-Chief