United Behavioral Health, which handles mental health coverage for UnitedHealthcare of New England members, has agreed to increase its reimbursement rates for Rhode Island psychiatrists, psychologists and other providers.
United CEO Stephen J. Farrell announced the change in a letter to the Rhode Island Medical Society that his office also shared with the PBN. The society had hosted a meeting with United officials and leaders of the mental-health provider community in November to try to try to persuade United to pay providers better and improve the way it handles mental health coverage in general.
United had promised to respond by Christmas, and Farrell sent his letter on Dec. 23.
“Recognizing that Rhode Island is a unique market, United Behavioral Health has decided to meaningfully adjust reimbursement rates in Rhode Island for all license types for common assessment, therapy, medication management and psych testing,” he wrote.
“United Behavioral Health will formally communicate the specifics to its network providers in January 2005,” he added. “Aggregate MD reimbursements will rise to the level of Medicare and the overall increase for MDs and non-MDs will average 20 percent.”
Providers had also expressed concern that United didn’t have enough people in its network to meet Rhode Islanders’ needs, especially with 52,000 new members expected to join United with the new state employee coverage contract.
In his letter, addressed to Dr. Fredric V. Christian, president of the medical society, Farrell said United was “committed to an intensive recruitment” of 50 providers outside its network that had been identified as “high volume” based on state workers’ usage of their services in the last year.
“The recruiting effort has begun, and will move forward regardless of the outcome of the pending court action,” Farrell wrote, referring to an appeal of the state contract award due to be heard by the state Supreme Court on Jan. 18.
“In addition, our network is open to any interested Rhode Island clinician who meets United Behavioral Health’s credentialing standards,” Farrell continued. He said United was moving forward with “expedited credentialing” for Rhode Island clinicians, so rather than taking 90 days, it would take 60 days from the date of receipt of a “clean” application.
United did not acquiesce to the providers on one key issue: they wanted to get rid of a pre-authorization system that requires people to call United before they can see a provider, and a requirement that providers periodically submit treatment plans to get permission to keep seeing a patient.
United Behavioral Health “is committed to reviewing the quality and appropriateness of treatment provided to its members at all levels of care,” Farrell wrote. “In that context, we require prior authorization for outpatient care. Since members utilizing more than 10 visits tend to be our most clinically complex cases, the treatment plan review process is used to ensure that they are receiving high quality services that are the most appropriate for their clinical condition. This process is not used to arbitrarily deny services for lack of medical necessity, lack of prior authorization or to create barriers to access.”
Farrell did acknowledge that United’s call center had been taking too long to answer calls in the last two months, but said since then, over 50 customer service representatives had been added to correct the problem. He also acknowledged that United had fallen short of its 99-percent payment accuracy standard with Rhode Island mental health providers, and said “specific initiatives” had been launched to correct that problem by the first quarter of 2005.
Providers had also complained that United forced them to send claims to multiple sites, often creating a mess that left them uncompensated. Farrell said United’s system already addresses that, but a consolidated system is “under discussion.” But providers should be filing claims through the Web, Farrell added, as United “strongly encourages” them to.
Finally, Farrell said United Behavioral Health is hiring a Rhode Island “ombudsperson” to represent the company at an executive level and build relationships with providers and facilities. The position should be filled by Jan. 30, he said.
“The goal of both UnitedHealthcare and United Behavioral Health is continuous improvement that enables us to exceed our standards and those of the State of Rhode Island,” Farrell concluded. “We look forward to continued dialogue with respect to our progress in these areas.”
