The Data Agenda

Saturday, October 26, 2013

An Affordable Care Act takeover in view

The Affordable Care Act mandates mental health benefits in insurance coverage, and the 2008 mental health parity law, which requires private and public insurers to cover mental health needs just as they do medical conditions by charging similar co-pays, for example.

“It’s a big change for us,” said Barbara Griswold, a marriage and family therapist in San Jose, Calif. “I spent all of my life setting up this practice where I choose my clients, I choose my hours.”

In just the last few months, Griswold has weighed a new contract with a giant health insurer, warned other therapists to watch what they’re signing in payment negotiations and considered the extinction of her own solo practice. “The idea of me moving into an interdisciplinary practice where somebody else is taking care of my billing, and someone is choosing my clients for me—there is a loss of autonomy that a lot of therapists are frightened about,” Griswold said.

Organizations that advocate for mental and behavioral health, groups that long complained they were treated as second-class providers, have applauded the federal laws. “Some people have paid for mental health out of pocket because they didn’t have mental health insurance,” said Dr. Katherine Nordal, executive director for professional practice at the American Psychological Association. “I think now they’ll expect their providers to accept insurance.”

But inclusion into the mainstream has come with some unhappy caveats: Cash was simple. Patients used to paying $150 in cash for a therapy session will, with some limitations, be covered by their health plan.

That means many therapists will have to figure out innumerable insurance plans and byzantine billing codes for the first time. “A lot of people come to me and they’re almost falling apart,” said Griswold who wrote a book called, “Navigating the Insurance Maze: The Therapist’s Complete Guide to Working with Insurance – and Whether You Should.” “It’s almost like a therapy session with these therapists. Seriously! I had a woman cry on my couch. She was like, ‘I don’t know how to do this!’”

Therapists who already accept insurance typically take a big pay cut since insurers negotiate fees that are about half of what they charge for cash visits. Blue Shield of California, for example, recently asked Griswold to accept a 10- to 30-percent discount off of her already discounted rate for patients who will buy health plans through the new online insurance marketplace. She refused and then wrote about the negotiations in her popular newsletter. “I put out in my newsletter, ‘Do you even know what you signed?’ And people wrote back, ‘Oh my God, I had no idea!’”

In many ways, therapists are encountering what medical doctors have complained about for years: the confusing and confounding – some say hostile – insurance bureaucracy that providers must tangle with in order to get paid. Therapists are expected to invest in expensive electronic billing software and electronic health records and comply with a tome of regulations.

Source: [ACA] changes how therapists do business

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