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An anxious month for social workers, psychologists and psychiatrists

January 28, 2013 in Insurance Bills, Member Stories, mental health

If you visit your therapist this month or next and he or she seems stressed out, it could be about money. Here’s why.

Therapists who accept health insurance submit a bill that includes a code for your visit.  90862 was, for example, a very common code for a medication adjustment visit to a psychiatrist.  As of this month, almost all the mental health codes are changing and this is causing a lot of anxiety.

Therapists aren’t sure which code to use and, they aren’t sure how much they’ll be paid.  Insurers say the new codes, which are reviewed and set by the American Medical Association, will likely mean lower reimbursement rates for therapists who don’t prescribe drugs.  Insurers say they won’t cover some of the codes at all. Many therapists are angry and discouraged.

“The Governor and the President are asking for more emphasis on mental health, but then the coding requirements increase and the reimbursements go down,” says Jonas Goldenberg with the Massachusetts chapter of the National Association of Social Workers.

Psychiatrists may see an improvement in payments for some visits because they’ll be able, for the first time, to bill for medical care they provide while monitoring the effects of medications.  But the new codes do not resolve ongoing concerns about whether mental health providers are paid at the same rate as are doctors who deal with physical health.  Under the new codes, it does not appear that psychiatrists who evaluate a patient’s physical response to medication will be paid what an internist would to make a similar evaluation.

“If a psychiatrist does the same work as any other physician, they should be paid the same,” says Don Condie, the Immediate Past President of the Massachusetts Psychiatric Society. Equal pay would “benefit patients because we’re trying to find a way to pay for the care of complex patients who take a lot of time but for whom, currently, there is little financial incentive to take care for.”

The American Psychiatric Association has posted guidance for members here.

Jeffrey Simmons, medical director for behavioral health at Blue Cross Blue Shield of Massachusetts (BCBSMA)says the insurer just received the new codes in late December but hopes to revise billing software and have a new reimbursement plan out by the end of this month.  Simmons says “once providers get used to the new system, everything will settle down pretty easily.”

But many therapists aren’t sure. So be ready if the therapist you or your child sees brings up the delicate issue of payment. It’s a hot topic in the mental health community right now.

Note: A spokeswoman for BCBSMA says the insurer pays psychiatrists and primary care providers at the same rate for the same services.

6 responses to An anxious month for social workers, psychologists and psychiatrists

  1. I am a Clinical Psychologist. There are several other things that have not been mentioned in this article. 1. The length of a therapy session has been decreased from 50 minutes to 45 minutes. Clients are not being notified by insurance companies about this change. 2. The rate of reimbursement from insurance is either remaining the same or being decreased. This has been true for the past 4 years, to the tune of about 15% from certain insurances. Blue Cross has not notified providers about their rates. The say they will do this 1/31, retroactive to 1/1. How can they say: “You are taking a pay cut. Keep working. We’ll let you know how much your pay cut will be – a month after it takes place.” 3. Decreases in payments by insurers will increase how much clients have to pay if they are using out of network benefits. So, clients pay more for their visits. At the same time, their premium costs are increasing. 4. Many providers are dropping off insurance panels for these reasons. It is increasingly difficult for clients to find an experienced psychologist or social worker who accepts their insurance. It is next to impossible to find a psychiatrist that does. 5. Mental health visits are something that clients have trouble advocating for, since it often would involve sharing this information with an employer or HR department, and people worry about doing that. 6. Mental health treatment is something that is more necessary in our society (for example: trouble youth who shoot innocent people in elementary schools, the epidemic of military suicides, increasing depression and self harm in the adolescent population) not less.

  2. Faith – lots of interesting points. On no. 1 – I heard that the code for a standard visit was a range – not set at 45 mins. – is that different from what you are hearing?

    Do you see patients? If so, what are you telling them about how the coding changes will affect the length or cost of their visits?

    • There is a range – technically the session can be from 38-52 minutes. However, the code (90834) is called 45 minute psychotherapy, as opposed to the previous code (90806) which was called Individual Therapy 45-50 minutes. Some insurers are adjusting rates to account for the decrease in time, some are keeping rates the same, and others have not posted so I am not sure what they will be doing with the rate.

      I do see clients. I have been telling them, “insurance has decided a therapy session is now 45 minutes.” It does not affect their cost (if they are seeing me as an in-network provider) – their co-pay will remain the same. However, it does affect my overall rate of pay. And of course, their sessions are shorter, which is very hard for some people to adjust to.

  3. This is true INSANITY! Each year my pay drops from BCBS of MA. I am in essence taking a pay cut every year. I give my clients a 60 min. hour, I can not imagine now telling my clients – sorry we are now stopping 15 minutes early.

  4. Not only are insurance companies reducing our rates, but I’ve heard psychiatrists and other medication providers will now be able to double-bill, meaning they can also bill for a therapy session, which reduces their session limits. It seems psychologists, social workers and other mental health providers are getting pushed out of being able to provide such important, and yet dis-valued services.

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