In the News

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.

– ### –
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.

Leave a comment

CliniciansUNITED in Commonwealth Magazine

An op-ed highlighting the need to limit clawbacks on mental health services, signed by CliniciansUNITED Executive Committee member Erica Kirsners, ran in Commonwealth Magazine.

Clawbacks threaten mental health services

Measure would put limit on insurance companies’ reach

IMAGINE BEING WORRIED sick, struggling to find a mental health clinician to treat your 12-year-old child who is so anxious that he has not been able to go to school for two weeks.  You’ve called dozens of private mental health clinicians and treatment centers, day after day, only to hear that they are full and not accepting new patients.

Imagine being a new mother suffering postpartum depression, unable to care for your infant, and unable to get treatment.

Both of these situations are unimaginable tragedies, yet increasingly common here in the Commonwealth, as affordable access to mental health and substance abuse services continues to decline. Perhaps even more tragic is that health insurance company practices are partially responsible for this situation.

One of the major problems clinicians have to deal with is retroactive claims denials, also called clawbacks. Insurance companies can recoup their payments to a clinician months, or even years, after a therapy session takes place and is paid for. Therapists secure prior approval from health insurance companies before treating their patients, and then have to adhere to billing deadlines (usually 60 or 90 days after each session takes place). No similar deadline exists for insurance companies.

Most of the clawback stories we have heard involve insurance companies discovering months – or more often, years – after the fact that they were not actually the insurance of record when the treatment took place. So, even though the therapist called the insurance to make sure their new client was eligible for service, and even though the insurance authorized the treatment, and even though the therapist was paid for the service by the insurance company – still, months or years later, the insurance company might discover they had made a mistake and demand the money back.Insurance companies are also able to demand to see all of a clinician’s files for a particular client, and can recoup payment if the files do not follow their particular guidelines. It’s like if your employer could take back paychecks you deposited years ago, just because you forgot to endorse the checks.

Handling insurance for MassHealth members has additional complications, and this makes it difficult to treat those very patients for whom the Commonwealth needs to expand access to mental health services.

One colleague of ours in private practice received a letter in the mail from an insurer, demanding $27,000 back. According to the Bureau of Labor Statistics, that amount is over half of the median salary of mental health practitioners and counselors. Clawbacks have led to gaping budget holes for the more than 80 community-based mental health and treatment provider organizations in Massachusetts.  One South Shore center recently reported clawbacks totaling over $137,000.

The fear of an insurance company retroactively demanding such massive payments has a chilling effect on private mental health clinicians and treatment centers alike – many of which are small businesses. When we discuss the many factors driving down access to mental health care in our state, look no further than these business practices. They are effective, subtle ways for insurance companies to deny critical behavioral health care.

Massachusetts must join over half of the country in passing legislation to protect health care providers from this practice of clawbacks. This session, state Rep. James O’Day and Sen. Michael Rodrigues have introduced a measure that would limit insurance companies to a six-month period for recovering payments for services already completed. It is a critical step toward addressing the grossly unfair business practice of clawbacks and leveling the playing field between mental health clinicians and insurance companies. Insurances should have to adhere to the same timelines and rules that they require of providers.

Our colleagues provide crucial mental health and substance abuse services day-in and day-out, in good faith and in accordance with the best insurance information available to them at the time. Insurance companies routinely violate this good faith and the spirit of our laws when they claw back payments from providers.

Massachusetts can and must do better if we are to address the crisis in access to mental health and substance abuse care.

Erica Kirsners, LICSW, is a clinician and social worker in Brookline. She is a Co-Chair of CliniciansUNITED Executive Committee, a campaign of SEIU Local 509.Vicker DiGravio is the President and CEO of the Association for Behavioral Healthcare, a statewide association representing more than 80 community-based mental health and addiction treatment provider organizations. 

Leave a comment

Intro to Cape Cod Model Workshop

CliniciansUNITED and The Gestalt International Study Center present

An Introduction to the Cape Cod Model:

A unique optimistic, and impactful approach to working with individuals, couples, and families 

Friday, April 28th

(make up from cancelled March 31st date)

Check In at 9:30am

Presentation from 10:00am-1:30pm

3 Continuing Education Credits for APA, NASW-MA, and MMCEP/MaMHCA  

Join us and learn about the Cape Cod Model©, a unique, optimistic and highly impactful intervention model for working with individuals, couples and families. Developed at the Gestalt International Study Center, Wellfleet, Cape Cod, it has been taught and implemented globally (in the U.S., Canada, Europe, the Middle East, and Africa) for more than three decades. The Cape Cod Model goes beyond positive psychology and strengths-based practices to engage the competence of the client or client system, while utilizing the power of awareness as a foundation for change. In this short workshop, you will learn and practice the basics of this model and experience how it can enhance your therapeutic impact. Whether you have experience with contemporary Gestalt practice or not, this program will offer a new approach and insights that will boost your effectiveness and renew enthusiasm for your practice. APA, NASW-MA, and MMCEP/MaMHCA CEUs will be available for this workshop which will be led by GISC faculty, Sharona Halpern, LMHC, and Stuart Simon, LICSW. 

FREE for all CliniciansUNITED Members

$20 for non members

Click here to become a CU member

 Click here to RSVP for the workshop

Location: SEIU Local 509’s New Office Location: 293 Boston Post Road West in Marlborough, MA

Light Lunch Will Be Provided. Feel free to share with colleagues and other interested clinicians.
Sponsored by CliniciansUNITED (CU) and the Gestalt International Study Center (GISC). CU is a multidisciplinary group of private practice behavioral health clinicians who are associate members of SEIU Local 509, the Massachusetts Human Service Workers Union. GISC is an educational nonprofit organization offering advanced professional training worldwide for leaders, consultants, coaches, and therapists.he
Comments Off on Intro to Cape Cod Model Workshop

Boston Globe Editorial | Mandate treatment, funding for mentally ill

Gerry Hill, father of David, an Eastham man suffering with mental illness who was shot and killed by police.

Gerry Hill, father of David, an Eastham man suffering with mental illness who was shot and killed by police.

NANCY CHIERO WAS as devoted as she was patient with her son Lee. The 35-year-old Uxbridge man had spent his life struggling with psychotic delusions, which would periodically send him to the emergency room for a prescription for medications. Those brought a brief respite, but Lee, who lived in his mother’s basement, would soon cycle off the meds and the visions would return. In 2007, caught in the grips of paranoia, he pushed her down the stairs and fatally stabbed her in the eyes — capturing the murder on videotape.

The story of the Uxbridge mother and son is emblematic of the state’s failed policies for treating those with serious mental illness. In a powerful series called “The Desperate and the Dead,” the Globe’s Spotlight team chronicled decades of tepid response, persistent underfunding, and governmental neglect that has thrown mentally ill patients into the streets and left families, police, and ER doctors with an enormous burden of care.

Since 2005, the series reported, more than 10 percent of all state homicides in which a suspect is known were allegedly committed by people with a history of mental illness or its clear symptoms. The Globe built a first-ever database of such cases; the numbers show that over the past 11 years at least 139 people in Massachusetts have died violently at the hands of a person with a diagnosed mental illness, or strong signs of one.

The arc of mental health care was supposed to be different, especially in the Bay State, where Frederick Wiseman’s shocking 1967 documentary, “Titicut Follies,” exposed humiliations inflicted on patients at Bridgewater State Hospital for the criminally insane and prompted pledges for change. State officials moved to shut down mental hospitals, with the aim of placing patients in more humane community clinics. The number of inpatient psychiatric beds in the state declined to 671 as of last year, from a peak of 23,560 in 1953, according to Spotlight.

But that robust system of community care never materialized. State officials slashed funding for inpatient mental health care by more than half from 1994 to 2013, at the same time that some treatment was being farmed out to private companies and nonprofits. But nearly a third of community mental health providers in Massachusetts reported closing clinics from 2013 to 2015, including the sort of intensive programs that could have benefited Nancy Chiero and her son.

Closing the gaps left by the legacy of deinstitutionalization is, front and center, an essential job of government. Cities like San Antonio provide a model, with aggressive funding of a system to handle psychiatric and substance abuse crises and move people from jails and ERs into treatment, Spotlight reports. There are other signs of progress in Massachusetts: In 2015, the state received nearly $1 million in federal seed money intended to establish pilot community clinics. And Governor Charlie Baker’s administration has put $41 million into MassHealth reimbursement rates — as private insurers seem to be fleeing in droves.

Finally, change is needed in state law in order to protect families, friends, and the public from mentally ill patients who pose a danger to others. Massachusetts, with its strong support for civil liberties, is one of only four states without a law that allows courts to compel patients with a history of noncompliance to undergo treatment. Such “assisted outpatient treatment” laws have led to better health outcomes in other states: patients are escorted to settings where they receive required medications. And while psychiatric medications can cause unwanted side effects — and research sometimes seems stuck in another era — they can also be effective in quelling symptoms.

It’s important to note that the vast number of those with mental illness are not violent, and feel stigmatized by any broad-brush approach. But legislators could couple the law with more funding for community clinics, as well as education and training. It could ultimately help patients like Lee Chiero and those who love them.

Read the full editorial from The Boston Globe.

Leave a comment

CliniciansUNITED In The Boston Globe’s Spotlight

On Sunday, August 28th, The Boston Globe printed their latest installment in their Spotlight series on mental health care in Massachusetts. They turn their attention to the underfunding of mental health services and cite our 2015 study, The Challenges of Private Practice: A Study of Clinicians’ Experiences Providing Mental Health Care in Massachusetts.

Click here to read the article. Click here to read the study.

Leave a comment

Members Meet with Congressman Kennedy

IMG_5333_1

Last week, CliniciansUNITED members met with Congressman Joe Kennedy III to discuss how we can work together to tackle the mental health care access crisis in Massachusetts and throughout our country.

The opportunity to meet with Congressman Kennedy came after our own published response to his well-received letter in the Herald News, where he outlined his current legislative efforts to tackle our country’s “systemic inadequacies deeply entrenched across the entire continuum of mental healthcare.”

From recognizing insurance companies’ high mental health claim denials (nearly twice the rate of physical health claims), to tracing how lowered provider reimbursement rates have stunted mental health care access, our conversation focused on how we can collaborate to make progress on these access issues in Massachusetts and across the country.

We also shared our progress on current state-level legislative initiatives to even the playing field between clinicians and insurance companies, along with our survey data illuminating the systemic barriers Massachusetts providers currently face.

CliniciansUNITED hopes to keep the conversation going with Congressman Kennedy, coordinating state level and federal initiative to truly expand mental health care access here in the commonwealth and beyond.

See more pictures from the meeting here.
Read CliniciansUNITED member Heather Grosso’s published letter here.

Leave a comment

March is National Social Work Month!

Each and every day, social workers confront some of the most challenging issues facing individuals and families throughout the Commonwealth. Together, they serve some our most vulnerable populations — tackling the opioid crisis, keeping at-risk children safe, providing critical mental health services and more. Whether directly or indirectly, we’ve all been touched their critical work.

That’s why National Social Worker Appreciation Month is so important: it is time to recognize the immeasurable impact these talented professionals have in our communities.

Join Governor Charlie Baker, U.S. Senator Elizabeth Warren, State Senate President Stan Rosenberg and many others in sending your message of thanks today. Use the links above to tweet, send an e-card or post your photo. Let’s show our social workers just how much their work is appreciated in Massachusetts!

Leave a comment

Experienced delays in your BCBS/HMO payments? We have answers!

BCBS LogoIn recent weeks, many clinicians have reported delays in receiving payments from Blue Cross Blue Shield (BCBS) HMO plans. Calls to BCBS left several clinicians with even more questions — from the cause of the delays to exactly when they might expect  to see payment.

Our union, CliniciansUNITED / SEIU Local 509, reached out to our contacts at Blue Cross to get to the bottom of this weeks-long delay, and the insurer issued a Managed Care Behavioral Health Provider Update (see below).


BCBS HMO MANAGED CARE BEHAVIORAL HEALTH
PROVIDER UPDATE

A 2016 calendar year system enhancement to automate the processing of Managed Care Behavioral Health services is in the final implementation stage. The change will improve the accuracy and timeliness of Managed Care Behavioral Health claims in support of the first 12 visits not requiring authorization.

Managed Care claims for dates of service after 1/1/16 will be released by the end of February. There is no impact to PPO Behavioral Health Claims.


Based on what we’ve learned, CliniciansUNITED expects the final pieces of this ‘system enhancement’ to be implemented by the end of February — so providers should see payments no later than the beginning of March. Some clinicians may see reimbursements as early as this week.

As many clinicians have pointed out, some claims will have passed the 45-day statutory limit by the time everything is sorted out. We have ensured that Blue Cross Blue Shield is aware of statutory requirements to pay interest on these claims.

While we now have answers and a firm timeline, there is still work to do. We will need to hold BCBS accountable to its stated deadlines — and we will work to make sure every clinician receives any interest owed. 

Click here if you have faced challenges with Blue Cross Blue Shield HMO claims in recent weeks.

Leave a comment

WBUR | Mass. AG Shifts Health Care Costs Conversation To Behavioral Health

Attorney General Maura Healey speaks during a press conference at the State House in June. (Jesse Costa/WBUR)

Attorney General Maura Healey speaks during a press conference at the State House in June. (Jesse Costa/WBUR)

If you have ever tried to get more than a doctor’s appointment for deep depression, alcoholism or a drug addiction, you already know that figuring out where to get care and who will help cover the cost is messy.

Now, that struggle is spelled out in the first health care cost trends report from Attorney General Maura Healey. It takes stock of behavioral health benefits and the low health insurance pay rate for these services in Massachusetts. Healey is shifting the focus of her office’s health care cost report after several, under former Attorney General Martha Coakley, that highlighted the wide gaps between payments made to high- and low-cost hospitals.

Healey says she’s changing gears because “it’s really important to look at the whole health of the patient.”

“We need to get to a place where we treat people who’ve got mental health, substance abuse issues in the same way we treat patients with diabetes or with cancer or with broken bones,” Healey says.

Seventy-nine percent of Massachusetts residents enrolled in MassHealth or ConnectorCare have coverage that separates general medical care from mental health and substance abuse. For members of commercial health plans. that number is much lower but still significant: 31 percent.  Healey’s report does not say that the separation is necessarily bad, but that the state needs a better system of sharing patient information between medical and behavioral health providers, and more coordination of care. [Read the full article at WBUR CommonHealth.]


ADDITIONAL RESOURCES

Leave a comment

Springfield Republican | Survey: Mental health patients turned away from treatment in Mass. over insurance issues

By Shira Schoenberg, Springfield Republican/MassLive.com
(Originally published on May 6, 2015. Read the full article here.)

Low insurance reimbursement rates and administrative challenges are affecting the way mental health professionals are practicing in Massachusetts, according to a survey of mental health professionals released Wednesday by the UMass Donahue Institute and commissioned by a group of mental health clinicians.

Christina Citino, a UMass Donahue Institute senior research manager, said the survey results suggest that issues related to the insurance company-doctor relationship, such as low reimbursement rates, “are affecting quality as well as access” to mental health care.

The survey was commissioned by CliniciansUNITED, an advocacy group of behavioral clinicians affiliated with the SEIU Local 509 union. Researchers received completed surveys from 785 clinicians, including 662 in private practice – primarily social workers, psychologists and mental health counselors.

The survey found that among private practice clinicians, 81 percent reported turning away at least one potential patient a month, and 44 percent turned away at least five potential patients per month. The most common reason for turning someone away, named by 61 percent of clinicians, was not being covered by the patient’s insurance.

The survey found cases of clinicians not wanting to join an insurer’s panel and, on the other hand, insurers not wanting to add clinicians to their panel. The vast majority of clinicians surveyed (84 percent) take at least one kind of insurance. But of those who take insurance, 35 percent had dropped off of one insurance panel in the last five years, a decision that was made 90 percent of the time because reimbursement rates were too low.

At the same time, 41 percent of clinicians, a majority of them mental health counselors, reported trying to join an insurance panel but not succeeding. The main reasons given were that the insurer was not accepting new providers in their service area (68 percent) or was not accepting any new providers (53 percent).

More than half of the clinicians reported that they had started taking fewer patients with particular insurance plans or they had changed their practice due to insurance company policies. A large number of those who made a change were working longer hours (41 percent), but large numbers also cut back on care, either by shortening sessions (28 percent), seeing patients less frequently (34 percent), accepting less complicated patients (34 percent) or taking more clients who could pay privately (29 percent).

The union is likely to use the study to try to gain support for a bill that would let clinicians bargain collectively for benefits like higher reimbursement rates from insurance companies.

Leave a comment