NEWS: End Clawbacks for Mental Health Treatment

Bill limiting insurance clawbacks is key step toward addressing access to mental health care

BOSTON, MA – Today, private mental health clinicians organized through SEIU Local 509’s CliniciansUNITED campaign are testifying before the Joint Committee on Financial Services in favor of legislation to limit retroactive claims denials by insurance companies. This practice, known as clawbacks, is in effect a subtle way for insurance companies to deny critical behavioral health care.

Currently, insurance companies can recoup their payments to a clinician months, or even years, after a therapy session takes place and is paid for, even though therapists secure prior approval from health insurance companies before treating their patients, and then adhere to billing deadlines (usually 60 or 90 days after each session takes place). No similar deadline exists for insurance companies. As a result, companies have demanded that private mental health clinicians pay back thousands of dollars for services rendered years ago in good faith.

The financial burden and uncertainty created by unlimited clawbacks has a chilling effect on therapists and is a limiting factor on their ability to treat patients. More and more clinicians are choosing to leave insurance panels because they find the requirements, the reimbursement rates, and retroactive claims denials too difficult to accept. If there are fewer therapists accepting insurance, people seeking mental health and substance abuse services have a harder time finding qualified therapists to work with at fees they can afford.

“In order to tackle the crisis in access to affordable mental health care, we have to address the insurance practices that are limiting providers’ ability to treat their patients,” said Erica Kirsners, a clinician and social worker in Brookline. “We clinicians treat our patients in good faith and in accordance with the insurance information we have.  Insurance companies should also have to act in this good faith and in the spirit of our mental health access laws.”

CliniciansUNITED supports legislation introduced by Representative Jim O’Day and Senator Michael Rodrigues (H.2193/S.582) that would limit insurance companies to a six-month window for retroactive claims denials.

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CliniciansUNITED is a multidisciplinary group of behavioral health clinicians who are associate members of the Massachusetts Human Service Workers Union, SEIU Local 509. Together, we are fighting to ensure each and every Bay State resident has access to quality, affordable mental health services — and to bring about the fair reimbursement policies and practices needed to make universal access possible.

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