January 29, 2008
PTSD DEFINITION, TREATMENT, AND COST
By: Veronica Rose, Principal Analyst
You want to know (1) the definition of post traumatic stress disorder (PTSD), (2) how many Connecticut veterans have been diagnosed with PTSD since 2001, (3) the percentage of Iraqi veterans returning to Connecticut with PTSD, (4) the cost of treating PTSD and how long treatment lasts, (5) if the state requires insurance companies to cover treatment, and (6) if the Connecticut Veterans' Home provides treatment for veterans.
“Post-traumatic stress disorder (PTSD) is an anxiety disorder that some people develop after seeing or living through an event that caused or threatened serious harm or death. Symptoms include flashbacks or bad dreams, emotional numbness, intense guilt or worry, angry outbursts, feeling “on edge,” or avoiding thoughts and situations that remind them of the trauma. In PTSD, these symptoms last at least one month” (National Institute of Mental Health). Traumatic events that may trigger PTSD include military combat, natural disasters, and violent crime.
We found no data on the number of Connecticut veterans diagnosed with PTSD. Also, we found no verifiable data on the cost of treating the illness. The cost varies, depending on such factors as (1) the extent of the illness (e.g., mild or chronic); (2) the type of treatment (e.g., cognitive behavioral therapy or medication); and (3) how long treatment lasts. The length of treatment will depend on several factors, including the severity of the illness. PTSD treatment can last three to six months for some people and up to two years or longer for people with other mental health problems, according to the National Center for Posttraumatic Stress Disorder.
With a few exceptions, state law requires “coverage parity” for all of the mental disorders classified in the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (currently DSM-IV). This means that an insured person cannot face a greater financial burden for mental health coverage than for any surgical, medical, or physical condition. Because PTSD is not one of the exceptions, it appears that the parity law requires coverage for this illness. Some states, including Illinois and Vermont, have parity laws comparable to Connecticut's (see Table 1).
According to Commissioner Linda Schwartz, the Connecticut Veterans' Affairs Department has a contract with the federal Veterans Department to provide treatment for mental health services. Apparently, because of staff shortages, the treatment is currently being provided only at federal sites but emergency treatment may be provided on-site at Rocky Hill.
The Diagnostic Statistical Manual of the American Psychiatric Association includes the criteria most widely used in the United States to classify mental disorders. The diagnostic criteria for PTSD in its current manual (DSM-IV) may be summarized as follows:
1. exposure to an extremely stressful and traumatic event “that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others”;
2. persistent “reexperience” of the trauma (e.g., intrusive recollections of the event, nightmares, or flashbacks);
3. persistent avoidance of activities and stimuli reminiscent of the trauma;
4. emotional numbing (e.g., difficulty experiencing positive emotions or markedly diminished interest or participation in significant activities);
5. persistent symptoms of increased arousal not present before the trauma (e.g., difficulty falling asleep, difficulty concentrating, irritability or outbursts of anger, and hypervigilance); and
6. symptoms last for more than one month (DSM I-V, 309.81, attached).
STATE LAW AND INSURANCE COVERAGE FOR PTSD
Connecticut is among several states that have mental health “parity laws” prohibiting health care plans from setting more restrictive limits on coverage for mental health disorders than for physical disorders or diseases (CGS § 38a-488a et seq.). The laws apply to visit limits, deductibles, and co-payments, among other things. Connecticut, Illinois, Maryland, and Vermont are among the states that require coverage parity for all of the mental disorders, including PTSD, classified in the Diagnostic and Statistical Manual of Mental Disorders (currently DSM-IV). Some states, including New York, limit parity coverage to a specific list of biologically based or serious mental illnesses, not including PTSD. Other states, including Louisiana (LA. Rev. Stat. § 22:669) and New Hampshire (New Hampshire Rev. Stat. 417-E:1) specifically list PTSD among the illnesses that are subject to parity coverage. (For a comparison of state mental health coverage laws, see AACAP State Parity Update, October 2005; see also State Laws Mandating or Regulating Mental Health Benefits, December 1, 2007, NCSL at http://www.ncsl.org/programs/health/mentalben.htm.)
Although Connecticut's parity law prohibits health care plans from imposing more restrictive limits on coverage for mental disorders, plans may still subject all types of care (mental, medical, surgical, and physical) to utilization review. Utilization review is the prospective or concurrent assessment of the need and appropriateness of treatment or care given or proposed to be given to an insured. While a plan may not discriminate on the basis of mental disorders, it may make a judgment about the level or extent of any given recommended treatment. A particular treatment strategy may be denied or restricted on the grounds that it is not “medically necessary” or “medically appropriate.”
A person denied or refused any service, procedure, or an extended hospital stay because of a utilization review may file an appeal internally and, if the decision is not reversed, externally to an independent panel.