Recently, Roberta Russell, PhD, LICSW, member of NASW-MA and the Chapter’s HMO/MCO Commission, went with a group of private practice clinicians from Western Massachusetts to meet with the Massachusetts Attorney General’s (AG) staff.
Before providing you a brief synopsis of the meeting, based on Roberta’s and her colleague’s reports, you should know that the AG is very interested in learning more about the experiences of providers/clinicians and clients, with the State’s insurance companies, health maintenance organizations, and managed care organizations . They are very interested in knowing specifics. Specific complaints, comments, and concerns should be sent to Stephen Vogel, Assistant Attorney General, at Stephen.email@example.com.
The meeting with the AG’s staff was quite comprehensive, and lasted more than an hour.
The issues discussed included:
- Concerns about closed or restricted panels and the negative impact on clients
- Providers receiving treatment authorizations, then not getting claims approved
- The difficulty for providers to recoup legitimate, unpaid claims from the companies
- Clients being dropped from their insurance plans or coverage changing without adequate notification
- Providers leaving networks/panels due to low reimbursement rates and the time and revenue lost due to excessive call wait times and bureaucracy of the insurance companies
- Parity concerns of “carve-outs”
- Anti-trust concerns that forbid private practice social workers, and other clinicians, from discussing the reimbursement rates they receive from the insurance companies
- Lack of available mental health providers in the Berkshires and the Cape and Islands.
The AG’s staff want to hear from NASW-MA members and other clinical providers regarding the following concerns:
- Companies not paying money owed to the provider/clinician
- Demands to fill out forms for authorization, credentialing, appeals, etc., when the information has been previously provided;
- Requiring therapists to call and then being put on hold for excessively long periods (e.g. 10 minutes +);
- Refusing to pay valid claims that are submitted past their arbitrary limits of 60 or 90 days, etc.
- Documentation of income lost from denied claims that should have been paid
- Mistakes and errors by the companies
- Any violations of parity laws; for example, having to request authorizations for treatment, having treatment not authorized, denials of payment based on lack of medical necessity, and the quantity of paperwork required for doing these things
NASW-MA Chapter, on behalf of Roberta and her colleagues, want to encourage you to communicate with the AG’s office about insurance company practices such as those outlined above. We suggest your communications be professional, specific, and based on data or facts, not opinions or feelings. If we want to have a real impact, we need to approach our concerns as professionally and dispassionately as possible. You can contact the AG’s office via email to: Stephen Vogel, Assistant Attorney General, at Stephen.firstname.lastname@example.org.
For more information on how you can get involved in political action for Social Workers, as well as social and economic justice for all, contact Christine Poff, Director of Policy, NASW-MA, at email@example.com or 616-227-9635 ext. 12.