UnitedHealth Group's announcement that it will let treating physicians rather than managed-care overseers decide what care patients need does not apply to mental health services, a United executive said yesterday.

That exception, which United had not publicized, came as an unwelcome surprise to patients and mental health professionals, who learned of it through their own interactions with the company.

United, one of the nation's largest managed-care companies, shook the industry to its foundations this week and won praise from doctors and other adversaries when it announced that it would no longer require doctors to get United's permission before proceeding with covered services.

United said it was abandoning one of managed care's key cost-saving techniques because it cost more than it saved and caused frustration for doctors and patients alike.

But yesterday Saul Feldman, chief executive of United Behavioral Health, the company's mental health subsidiary, said patients and practitioners still need to get United's authorization before beginning treatments such as outpatient therapy or psychiatric hospitalization if United is to pay for the care.

"At this point more research is necessary, though the literature in general suggests that the costs would increase substantially" if United let mental health practitioners have the final say, Feldman said.

"There is in medical care much more evidence-based practice," while in mental health "you have a wide variety of treatment philosophies and methods, the great majority of which have not been evaluated in terms of efficacy," Feldman said. "While we've made a lot of progress" in determining which mental health practices are best, "we're still far behind medical care and we have a lot of catching up to do."

Advocates for the mentally ill, who have been fighting for "parity" in behavioral health benefits, criticized United's position as discriminatory.

"I guess they think their accountants are going to be better at psychiatry than they are at the rest of medicine," said Laurie Flynn, executive director of the National Alliance for the Mentally Ill.

"We've had situations where people are very ill, even suicidal, and they can't immediately be admitted to the hospital because they can't get pre-certification," Flynn said, speaking generally of the industry's practice.

Flynn said her organization would examine whether laws passed in many states mandating parity between mental health coverage and medical coverage prohibit United's double standard for pre-certification.

The United employees reviewing the care are trained clinicians, Feldman said.