When a Blue Cross & Blue Shield of Rhode Island subscriber needs to see a psychologist, the process is fairly simple, local providers say: Just make an appointment, and the provider handles the authorization, usually getting cleared for up to 30 visits.
For many UnitedHealthcare subscribers, it can be tougher. Most have to call for pre-authorization and explain why they need the service. United generally authorizes only eight to 10 visits, then requires the provider to submit confidential information to justify another six, and again for the next six, until the patient’s benefits are exhausted.
Seifert Systems Invests in Energy Efficiency to Strengthen Operations
For manufacturers, energy is more than just another operating expense. It plays a critical role…
Learn More
United also pays providers far less than Blue Cross – 54 percent for a diagnostic evaluation, and 67 percent for individual counseling and therapy, according to the Rhode Island Psychological Association – so fewer providers accept the insurance.
That’s why as soon as Gov. Donald L. Carcieri announced that the state had chosen United to cover its workers for the next three years, mental-health leaders immediately objected and urged officials to carefully negotiate mental health benefits.
As Richard N. Harris, chair of the Rhode Island Coalition for Mental Health, explains it, his group is concerned on two levels: How will the roughly 43,000 people covered by the state contract be personally affected? And how will United’s growing clout affect mental health coverage for everyone in the state?
“I think it’s going to limit access in the future,” Harris said in an interview.
United, whose mental-health coverage is managed by a subsidiary, United Behavioral Health, has made public assurances that state workers’ coverage won’t suffer as a result of the switch from Blue Cross.
Carcieri, for his part, has said the state is “working with United” to ensure that. The Rhode Island Medical Society has also stepped in, and arranged for a meeting last Thursday between United officials and mental-health leaders, including Harris.
The gap that providers say needs to be closed, however, is substantial.
Health insurance companies in general do not have a happy history with mental health providers. As Peter Oppenheimer, a psychologist in Barrington, put it, mental health “has been kind of the whipping boy” in terms of insurers’ restrictions.
Patients who just needed help with a difficult episode in life, for example, couldn’t get coverage if they just said that – they needed to be diagnosed with some mental-health problem. And until the federal government, two years ago, made it possible to get reimbursed for certain “behavioral health” evaluations and interventions, a psychologist couldn’t get paid for helping, say, a diabetic child cope with the difficulties of being the only one who can’t eat candy. (United still doesn’t reimburse for those services, but Blue Cross has recently started doing so.)
In an Oct. 21 letter to Carcieri, Harris noted that access to mental health services has long been costlier for consumers than physical health care. When an insurer such as United pays “woefully inadequate” rates to providers, they’re forced to leave the network, and consumers have to either pay out of pocket, or find another provider.
That harms patients, Harris said, because “in mental health, the relationship you have with a particular person is critical.”
Blue Cross’ own record with mental health providers has been rocky, too, but it has gained stature with them recently for two reasons: As part of its “health and wellness” initiatives, it has paid extra attention to behavioral health, and more important for providers, when Blue Cross adopted the Medicare pay scale as the basis for its reimbursements earlier this year, it did so across the board, whereas United excluded mental health from its planned rate hike.
Thus, according to Peter Erickson, of the Rhode Island Psychological Association, while Blue Cross’ rate for, say, individual therapy is about $100 per hour, a moderate discount from what a therapist would charge, United pays one-third less.
At this point, Erickson said, United “really hasn’t raised their fees in about a dozen years.” United’s reimbursement system is also more complicated, he said, so providers have to spend a good deal of time trying to get paid.
United’s setup can also create difficulties when patients have problems that aren’t solely mental or solely physical, Oppenheimer noted. When a young patient in his practice was tested for a possible brain tumor, he said, United bounced the claim back and forth and took a year and a half to reimburse the practice.
“For us it’s this impenetrable shell game,” Oppenheimer said. “We can’t ever get to anybody who ever is responsible for anything.”
United spokeswoman Debora M. Spano said such problems are “unacceptable” and should’ve been addressed locally. But her take on the separation between UnitedHealthcare and United Behavioral Care, in general, was quite different: Mental health “is so important to us that we have a separate company to deal with it.”
Spano acknowledged that United’s mental-health reimbursement rates are a concern, and she said UBC is “looking at it now, but there has not been a decision yet.” The fact that company officials came here to meet with providers, she said, is a sign that they are trying to be “responsive” to them.
