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.
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.
In December of 2015, CliniciansUNITED members, staff, and bill sponsor Representative Jim O’Day testified in support of House Bill 925, An Act to Limit Retroactive Denials of Health Insurance Claims for Mental Health and Substance Abuse Services. This bill will:
• Limit both MassHealth and commercial health insurers to a six month period for recovering payments to a provider for services completed. When providers deliver a service in good faith and in compliance with eligibility rules, they should be compensated without fear of insurance companies taking back these reimbursements years or months after the services were provided.
• Require that MassHealth institute a back-end process to reconcile payment between payers without involving the provider. This process could mirror the current process in the auto insurance industry.
To read our submitted testimony, click here.
For more information about the bill, click here for the fact sheet.
In August, CliniciansUNITED submitted testimony to the Health Policy Commission on proposed changes to medical necessity criteria. You can read the full request for testimony with description of the proposed changes here. A snippet of our testimony:
“Clinicians spend an inordinate amount of unpaid time on the phone and completing online authorizations with insurance companies making the case for why their clients meet medical necessity requirements to continue treatment. The insurance representatives have never met the client, yet they make the decision on whether or not treatment is approved. How is this the standard of care that we are working toward keeping?”
To read CU’s full submitted testimony, click here.
On June 24th, Senate Bill 649, An Act to promote the accessibility, quality and continuity of care for consumers of behavioral health, substance use disorder and mental health services, had a hearing in front of the Joint Committee on Health Care Financing. CU members, staff, and allies testified in support of this important piece of legislation that would drastically increase access to mental health care in Massachusetts. This bill addresses access challenges by creating state action immunity for providers who choose to engage in joint negotiations with insurance providers on issues such as reimbursement rates and medical necessity criteria.
On July 16th, CU testified in front of the Joint Committee on Mental Health and Substance Abuse in support of House Bill 1812, An Act to promote accessibility and affordability of behavioral health and substance abuse services for recipients of MassHealth. This bill, filed by Rep. Jim O’Day, will require mental health carve-outs to make their contracts and executive compensation publicly available. The purpose of this bill is to shine a light on how effectively tax dollars are being spent to provide essential behavioral health and substance abuse services to those that need them most.