BCBSFL Flies Over The Cuckoo's Nest

[Brock]

Big insurer shakes up mental-health field

By Brittany Davis
08/10/11 © Health News Florida

Some mental health providers say they will no longer treat Blue Cross & Blue Shield of Florida patients in light of a “surprising” letter they received from the company last week.

The letter announces that the insurer will terminate contracts with behavioral health providers by Nov. 30 and turn over management to a Kansas-based managed care company, New Directions Behavioral Health.

Treatment providers who want to continue seeing BCBS-FL patients must apply to New Directions and sign a contract within 15 days.

Under the contract, caregivers would be paid 25 to 55 percent less than they were before and would not be able to refer patients to providers outside the network, said Dr. Stephen Ragusea, a Key West psychologist.

“I'm not going to sign it, and I don't think other providers will either,” he said.

The change also applies to Blue Cross's Medicare Advantage plan.

Winter Park psychiatrist Dr. Louise Buhrmann said she's concerned about patients who are bound to have their mental health care interrupted as a result of the change.

Depressed patients who can't see their psychiatrists may not take their medications and may end up in the hospital, she said. Also, it could be difficult for a psychologist to find an in-network psychiatrist for a patient who needs medications, she said.

Blue Cross spokesman John Herbkersman said the switch could help reduce costs for members of the company's health plans.

“A part of our mission is to make health care affordable for everybody,” he said.

He said he could not speculate on the potential loss of providers. New Directions did not respond to calls.

A June press release from BCBS-FL touts its partnership with New Directions, calling the company "one of the top thought leaders in the behavioral health field."

According to the New Directions website, the company also serves BCBS patients in Kansas and Arkansas.

BCBS-FL is a minority stockholder in New Directions, as are other Blues plans, Herbkersman said.

At least three providers who received the letter questioned the legality of the transition in light of the 1996 federal Mental Health Parity Act, which forbids insurance companies from financially limiting mental health services more than other types of medical care.

South Florida lawyer John Kelner said it's unlikely the company would lose a suit unless it could be demonstrated that the policy was implemented with the intent of not providing services.

I predict lots of suits being filed under the Mental Health Parity and Addiction Equity Act of 2008 (not to be confused with the Mental Health Parity Act of 1996).

I also see the sacking of a compliance officer.

[JMO]

Originally Posted by Brock

I also see the sacking of a compliance officer.

I sure hope so!

As a consumer, I am awfully tired of the games being played by powerful insurers/administrators. Like the way they "handled" Walgreens a while back.

[actexp]

Originally Posted by Brock

Big insurer shakes up mental-health field



I predict lots of suits being filed under the Mental Health Parity and Addiction Equity Act of 2008 (not to be confused with the Mental Health Parity Act of 1996).

I also see the sacking of a compliance officer.

Many insurers "outsource" MH in some fashion to specialized outfits, involving a network of providers and utilization review. People can always file suits, just not apparent to me on what basis they would have merit. fyi, I am not opining on the desireability of this from claimant perspective.

[Abused Student]

Originally Posted by actexp

Many insurers "outsource" MH in some fashion to specialized outfits, involving a network of providers and utilization review. People can always file suits, just not apparent to me on what basis they would have merit. fyi, I am not opining on the desireability of this from claimant perspective.

And if Medicare is involved they will have to show that their network is sufficient for their insureds needs. Medicare pretty much makes it so that if you have a preferred network that everybody has the chance to go to someone in network. That means there has to be someone in network within a certain radius.

[Brock]

Originally Posted by actexp

Many insurers "outsource" MH in some fashion to specialized outfits, involving a network of providers and utilization review. People can always file suits, just not apparent to me on what basis they would have merit. fyi, I am not opining on the desireability of this from claimant perspective.

By law, insurers have to provide MH/SA benefits on par with med/surg benefits. This includes access as well as cost-sharing and limits. Knowing they are outsourcing to a MH intermediary that is trying to strong arm providers to the point were access becomes negligible at best but most likely non-existant in several areas leaves the insurer in an actionable position. That combined with the Medicaid issues with access and bad blood and poor faith with current members will also lead to reduced market share. So, adding it all up I see a sacked compliance officer, CEO, COO, and possibley CFO depending on BCBSFL's C-suite structure.

[Brock]

Originally Posted by JMO

I sure hope so!

As a consumer, I am awfully tired of the games being played by powerful insurers/administrators. Like the way they "handled" Walgreens a while back.

There are more chapters in that story. Walgreens is still under investigation.

[Abused Student]

Originally Posted by Brock

By law, insurers have to provide MH/SA benefits on par with med/surg benefits. This includes access as well as cost-sharing and limits. Knowing they are outsourcing to a MH intermediary that is trying to strong arm providers to the point were access becomes negligible at best but most likely non-existant in several areas leaves the insurer in an actionable position. That combined with the Medicaid issues with access and bad blood and poor faith with current members will also lead to reduced market share. So, adding it all up I see a sacked compliance officer, CEO, COO, and possibley CFO depending on BCBSFL's C-suite structure.

Just playing devil's advocate because I don't know but nothing in the article indicated anything about limited access and it seems like the cost-sharing and limits would be reduced if they are able to limit their costs. Mental health care is (or at least was at my previous company) one of the fastest growing section of healthcare costs. It is hard to prove medically necessary items and therefore it is also a prime spot for fraud. Some doctor's getting their cash cow cut are going to whine. And if a mentally ill patient is going to quite taking their medication because they can't see their regular doctor I would pose that it is likely they won't stay on the pills most of the time anyways.

[erosewater]

If the government can strong-arm providers with reductions in reimbursements, why can't a private insurer? Are we going to control costs or not?

Insurers have been getting beaten up for not controlling costs, while providers get a free pass. Why is the insurer the bad guy and not the providers who will stop seeing their patients because they want more money?

[cubedbee]

Originally Posted by Brock

By law, insurers have to provide MH/SA benefits on par with med/surg benefits. This includes access as well as cost-sharing and limits. Knowing they are outsourcing to a MH intermediary that is trying to strong arm providers to the point were access becomes negligible at best but most likely non-existant in several areas leaves the insurer in an actionable position. That combined with the Medicaid issues with access and bad blood and poor faith with current members will also lead to reduced market share. So, adding it all up I see a sacked compliance officer, CEO, COO, and possibley CFO depending on BCBSFL's C-suite structure.

This isn't quite true. The 2008 law mandates that if 51+ employers choose to provide MHSA benefits (they can choose not to), then those MHSA benefits have to be on par with med/surg benefits. Doesn't touch small group or individual market. Network access is a qualitative measure, and it's arguable if this move even violates it for 51+.

[Brock]

Originally Posted by Abused Student

Just playing devil's advocate because I don't know but nothing in the article indicated anything about limited access and it seems like the cost-sharing and limits would be reduced if they are able to limit their costs. Mental health care is (or at least was at my previous company) one of the fastest growing section of healthcare costs. It is hard to prove medically necessary items and therefore it is also a prime spot for fraud. Some doctor's getting their cash cow cut are going to whine. And if a mentally ill patient is going to quite taking their medication because they can't see their regular doctor I would pose that it is likely they won't stay on the pills most of the time anyways.

My view is that, by telling the MH providers to take a 25% to 55% haircut in fees, they are going to lose a large chuck of their current provider network which specifically goes to the access issue. If you don't have providers, you don't have access especially if the providers are not allowed to refer to out of network providers. I would also be concerned about the quality of providers that do remain after those cuts.