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A State Catastrophic Health Insurance Plan and the Peer Review Process
D. Robert Fowler; Frank W. Sullivan; William O. Samuels
Psychiatric Services 1977; doi:
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Miriam Hospital Providence, Rhode Island

Brown University Providence, Rhode Island

Diagnostic and Evaluation Program Butler Hospital Providence, Rhode Island

American Psychiatric Association

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Abstract

Rhode Island instituted a catastrophic health insurance plan in January 1975. The state division of health insurance was concerned about the amount of money spent for psychiatric services during the first year—$98,000 of the total $516,000 spent on medical services. The state then proposed amendments that would markedly reduce the plan's benefits for psychiatric services. The Rhode Island District Branch of the American Psychiatric Association was successful in blocking the amendments when its peer review committee offered to review cases submitted for psychiatric services in order to help determine the necessity and appropriateness of treatment and the type of cases likely to be eligible for catastrophic coverage. As of February 1977 a total of 11 cases had been referred to the peer review committee.

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