"So far, it’s chaos. It’s hard to evaluate how widespread this is."
February 7, 2013 11:34 AM   Subscribe

“Compliance with treatment is a sketchy thing to begin with,” said Sam Muszynski, director of the office of health care systems and financing for the American Psychiatric Association. He fears that financial fallout may force some providers to disrupt care, leaving mentally unstable patients on their own temporarily -- or longer. “All it takes is one missed appointment,” he added. Changes instituted on January 1 to insurance claims codes have glitched the system by which mental health professionals get paid - prompting fear that many will have to stop providing care. More information on the changes to the codes.
posted by jbickers (8 comments total) 5 users marked this as a favorite
Man, that really sucks. I have trouble enough dealing with insurance companies when it comes to the two codes I use ("massage therapy" and "manipulative therapy", which LMTs can use interchangeably but most insurance companies believe otherwise). I couldn't imagine how frustrating it would be for a provider who uses a lot of codes, especially if they've just changed.
posted by hopeless romantique at 12:17 PM on February 7, 2013

Steven Perlow, president of the Georgia Psychological Association and a psychologist in private practice, says he hasn’t received January payments from private insurers, either.

It's February 7th. I am generally lucky if my customers pay my invoices net 60 - a lot of them drag me out to net 90 or longer so I'm having a hard time feeling sympathy for these doctors. Do like everyone other small business does - get your own line of business credit to tide you over and keep enough cash on hand to pay your employees.
posted by three blind mice at 12:34 PM on February 7, 2013

Moreover the "get this sorted for us or you know another Newtown" sounds to me like extortion.
posted by three blind mice at 12:37 PM on February 7, 2013

Yes, this is a HUGE thing, and I have a lot of personal experience with it as I do some work for a group of therapists which is being badly impacted.

It's a huge disruption in the cash flow. And whether you're accustomed to invoices being paid every 14 days or every 90, if that figure suddenly doubles, it becomes disastrous.

In the case of the group I work for, we went to a lot of trouble to make the coding switch happen as of the 1st. But the insurance companies have not.

The insurance companies had just as much warning as we did, but they are claiming that they were taken by surprise by all of this. Meanwhile the insurance companies are withholding payments until they get their own shit sorted out, and thus our therapists are being punished for the insurance companies' own incompetence.

When you get right down to it, though, it's all starting to seem like one big excuse to withhold payment for a little while longer. The insurance companies have long wanted to drive independent therapists and psychiatrists out of business, in favor of a clinical model which is more cost-efficient for them. And this "Oh we didn't know" line of BS is - in many people's minds - just a way to starve out a lot of the smaller practices.

Our practice has cash reserves. So do most. But how long can those hold out? A lot of the therapists were nearing retirement age anyway, and are thinking that they may as well take early retirement. If you're not getting paid, you may as well be not getting paid while you're at home puttering around the garden or visiting the grandkids.

All of which is too bad for a lot of reasons. Not least being that the people who really suffer are the clients, who suddenly find that they have even fewer treatment options than they did before.
posted by ErikaB at 1:00 PM on February 7, 2013 [4 favorites]

I wish there were more technical details about what is going on here. I wonder if there will be lawsuits if people actually go out of business due to (???) insurance companies (??) not being being able to process claims.

three blind mice: Yes, your business is set up for the billing cycles you discuss. And presumably your cash flow and ability to operate is dependent on people paying within the time-frames you are used to. What would happen if suddenly all of your customers started paying out 6-9 months after you invoiced them. I assume it would disrupt your business quite a bit; maybe your bank would help you out, I don't know. Also, who exactly is trying to extort what out of whom? I'm not sure it's extortion when you are trying to get paid what you are legally owed.
posted by el io at 2:05 PM on February 7, 2013 [1 favorite]

TBM is claiming extortion because of the suggestion made in the article that leaving mental health care patients in the lurch (which would happen if clinics have to close doors) could prove a danger to the patients or people around them.

I'm not sure I think of this so much as "extortion" as "a fair assessment of reality." There certainly are some folks who, without help, could prove such a danger to themselves or others.

Exactly to what degree this is true is, of course, a point that could be debated.
posted by Archelaus at 3:46 PM on February 7, 2013 [1 favorite]

There is a good explanation of the changes to the CPT codes over on Shrink Rap. From a patients perspective it could mean that you never know in advance how much you have to pay for your psychiatry visit. If you talk more about one thing than another, that changes the code that the psychiatrist can bill under, and thus changes how much you have to pay.
posted by SyraCarol at 5:10 PM on February 7, 2013 [1 favorite]

This is interesting. I wonder if this is related to a billing issue for my son's counselor that started cropping-up late last year?

Our insurer is Anthem. Since the time when the Earth cooled, mental health services have always been treated exactly like a doctor's visit...A copay. Then, beginning around August, we started getting these outrageous bills from our son's counselor . Suddenly, we were owing them hundreds of dollars for his sessions. Anthem was denying the copay and was telling the counselor's office that the charges were to be applied to our deductible. WTF???

After several tearful hours on the phone with Anthem (during which the Anthem CSRs outright lied to my wife, insisting that mental health has always been an out-of-pocket expense) we finally got someone to recognize that, in fact, the charges should have been a copay situation, and all the billing were re-submitted and settled. Whew!

Flash-forward to this week...We get a new bill from the counselor, again for hundreds of dollars. Calling Anthem again, we are now being told that mental health services are subject to both a copay and out-of-pocket payment. WTFWTFWTF???????
posted by Thorzdad at 6:18 AM on February 8, 2013

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