The study cites some examples in large employer-based plans for 2010 of NQTLs that were stricter for MH/SUD benefits than for medical/surgical benefits. Below are some of the more common types of NQTLs that appeared to be problematic:
- MH/SUD precertification requirements were more stringent than those used for medical/surgical benefits.
- Medical necessity criteria appeared to apply differently to MH/SUD services compared to medical/surgical services.
- Retrospective reviews were routinely used for MH/SUD services but not medical/surgical services.
- Reimbursement rates for MH/SUD services were based on lower percentages of usual, customary and reasonable standards than medical/surgical services.