Practice Management Alert

Question: I have been told that there is a new federal law prohibiting health insurers from denying coverage for suicide attempts. For example, one of the claims is for self-inflected wrist injury repair. What does the law entail, and how can I find it?

New Jersey Subscriber

Answer: A new federal law did go into effect July 1, 2002, concerning coverage for claims resulting from suicide attempts. If you have a claim reporting self-inflicted wrist injuries that your provider repaired, your insurance carrier must pay, provided that your claim is filed under a group healthcare plan that had 50 or more participants and is not self-administered.

Under the new Health Insurance Portability and Accountability Act, claims filed for these group healthcare plans warrant payback for injury treatment, regardless of the cause. For those up on health-insurance news, HIPAA usually means new privacy rules, but the monolithic health insurance act covers other regulations, including nondiscrimination on the basis of health factors.

HIPAA regulations prohibit applicable group plans or insurers from denying benefits based on health factors, including medical condition. For example, if the source of injury is the mental condition of depression, the most common reason for suicide, then the insurer must cover treatment for that condition. Expect insurers to pay for benefits on claims reporting suicide attempts unless the group plan is administered to fewer than 50 people or is self-administered. Go to the CMS Web site for more on HIPAA.