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Chapter Meets with Cigna and Tufts to Press for Changes

Author: Carol Trust, LICSW, Executive Director, Massachusetts Chapter, NASW

The Chapter continually monitors the policies of managed care companies (MCOs). Most recently we have met with the MCOs CIGNA and TUFTS.

In July, we received dozens of phone calls from NASW members who were members of the CIGNA outpatient mental health panel. The calls centered on three problem areas: the practice CIGNA employs for authorizing treatment sessions; a practice CIGNA employs regarding seeing parents of child clients; and the fact that CIGNA lowered the reimbursement rate of clinical social workers.

The first two issues have been chronic. The straw that broke the camel’s back was the third, as social workers were targeted more than psychologists and psychiatrists for rate reductions.

Carol Trust, immediately scheduled a telephone conference call with the President and Vice President of CIGNA to address these issues. She received an initially positive response from both in regards to these problems. The President, Keith Dixon, promised to promptly look into the two problem practices cited above (process for authorizing treatment sessions and for managing child treatment cases). He requested a month’s time to look into the problem of reimbursement for social workers.

We suggested that CIGNA representatives meet with our Private Practice Committees (Pioneer Valley, Berkshire and Greater Boston) to deal more directly with the problems clinicians are experiencing. CIGNA agreed to do this in the fall. In the meantime, if you are experiencing problems as a CIGNA provider, you are invited to let the company know of the details. It seems that the President had not received any calls about these problems and was surprised by the "Massachusetts Response.” Write: Keith Dixon, President, and Julie Vayer, VP Professional Relations and Network Operations, Cigna Behavioral Health, 11095 Viking Drive, Eden Prairie, MN 55344. Ms. Vayer is particularly interested in setting up some local meetings.

The Chapter continues to meet with TUFTS’ representatives to discuss issues of common concern. At the most recent meeting in August, NASW representatives, Rita Van Tassel, Amy Eden and Carol Trust, met with Paul Fulton, Director of Mental Health Clinical Services and BJ Perry, Manager of Ancillary Services. The two key issues were: Reimbursement for Collateral Services and identifying specialties.

Regarding the first, it is well known in the clinical community and in the media that a full range of mental health services for children are lacking for a number of reasons. One of these is that child treatment often requires a substantial amount of collateral work, which is not reimbursed. Clinicians wind up spending many extra hours at school meetings, on the phone, and talking with others involved in servicing a child, without being compensated for their time. It is hard for a clinician to stay in business if they are working pro bono on their child cases. This is a concern to both the MCO and to the clinician. The Chapter will continue to work with TUFTS as to reimbursement for collateral services.

The other issue deals with TUFTS’ being able to identify clinicians with specialties. This is important so those clients will be referred to providers who have the expertise to help them with the problem they are presenting. TUFTS is preparing a survey to send to all its mental health practitioners regarding their specialties and their accessibility. The NASW representatives gave some specific input into the survey. We shall continue to work with TUFTS.

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