Bupa, Healthscope hit stalemate over telehealth funding for mental health services

Health insurance major Bupa has cut back on funding for mental health day programs for patients since doctors began using telehealth.

Bupa says it has ‘made numerous attempts’ since April to reach an agreement with the Melbourne Clinic’s operator, Healthscope, to fund temporary telehealth services. Picture: NCA NewsWire/Tertius Pickard

Health insurance major Bupa has cut back on funding for mental health day programs for patients with eating disorders, drug and alcohol addictions, and other conditions since doctors began using telehealth, a psychiatrist at a prominent Melbourne hospital says.

Telehealth has emerged as a viable and convenient treatment option under COVID-19 restrictions, particularly Melbourne’s harsh stage four lockdown, which is aimed at limiting people’s movement to curb the spread of the highly infectious virus.

Michael Maloney, of the Melbourne Clinic in Richmond, said patients were being forced out of the hospital’s day programs for a range of mental health conditions because their insurer, Bupa, would not pay up.

Mental illnesses have soared during the COVID-19 pandemic, which fuelled a spike in depression, substance abuse, post-traumatic stress disorder and suicide.

Dr Maloney said Bupa’s decision to cut back on funding for the day programs would lead to higher costs in the long run via hospital admissions and to the distress of patients. In some cases, he said Bupa had reduced funding for a patient in the middle of a program.

But Bupa says it has “made numerous attempts” since April to reach an agreement with the Melbourne Clinic’s operator, Healthscope, to fund temporary telehealth services, which it has done with “all other private hospitals offering mental health services”.

Dr Maloney, however, said Bupa had been the only health insurer not to fund the Melbourne Clinic’s day programs.

“All of the other funds have been very comfortable with us running the same program we did face-to-face but with telehealth — but not Bupa. They have cut it in the middle of treatment for some patients, which is particularly dangerous,” Dr Maloney said.

“But not only that, if people jump up and down enough, they agree ex-gratia to keep funding the program. Of course, psychiatric patients aren’t alway the best at standing up for themselves.

“Day programs are strategic programs where you are empowering patients to take more control of their issues than just relying on a cocktail of medications. But most of them aren’t at the point where they can take on Bupa.”

Dr Maloney said day programs also aimed to prevent patients being admitted to hospital, which “wasn’t always helpful”.

“It certainly prevents, with the drug and alcohol patients, readmissions because they start to pick up skills in the inpatient program which we rehearse and reinforce in the day program. So in some ways (Bupa) are shooting themselves in the foot because it (funding the day programs) is saving them money.

“Without the day program, (patients) are out there, they’re isolated and they are going to revert to their old maladaptive behaviours. They are going to restart their drinking, their drugging, their eating disorder behaviours and self harming.

“Depressive symptoms have tripled in America during the COVID crisis, and there is no reason to think we are doing better.”

The funding cutback has fuelled fears that health insurers are seeking to influence more of the clinical care of their members in a step towards a US-style managed care model.

“There is only so much you can do with an inpatient admission, where again there is pressure on you not to go for more than 18 days, so there are elements of managed care already here in Australia.”

Dr Maloney said he had not spoken to Bupa about the lack of funding, which the health fund negotiates directly with the Melbourne’s Clinic’s operator, Healthscope.

A Bupa spokesman said Healthscope was the only private hospital provider not to strike a funding agreement for telehealth services.

“All other mental health hospital providers — 46 nationally, 11 hospital providers in Victoria — agreed to temporary telehealth funding agreements,” he said.