Patients suffer when reimbursements for mental health care are reduced

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Here is an article written by a nurse about the way an insurance company manipulates the coverage and prevents payouts.  The targeted population for this tactic is the mentally ill, who cannot advocate for themselves and require nurses and mental health professionals to do so for them.

This article is from the OregonLive.com, and is a guest post by Susan King.  She speaks eloquently and obviously from her heart.  Please read this article and let your elected officials know that this type of behavior by insurance companies is totally unacceptable to you.

Please visit the site for other articles that may interest you, too.  Don’t forget to leave a comment!

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By Susan E. King

Your editorial “Sick, insured, and nowhere to turn” (Oct. 2) exposed tactics that Blue Cross Blue Shield of Massachusetts has used to decrease the financial impact of their insured customers with mental illness on the company’s bottom line. Such tactics clearly discriminate against people trying to maintain their health and further stigmatize those struggling with diagnoses of mental illness.

Unfortunately, Massachusetts isn’t the only state in which health insurance companies try to evade the intent of mental health parity laws. In 2009, many mental health professionals across Oregon received notice from Regence Blue Cross Blue Shield that their reimbursement rates for provision of mental health services would be reduced by 25 percent. Why? According to Regence, these providers were not physicians and, as a result, they were being paid “above the market” for their services. Nurse practitioners who had a large number of patients covered by Regence and who were treating the exact same diagnoses (and billing under the exact same codes as psychiatrists) were subjected to this arbitrary decrease in reimbursement rates.

The result? According to a recent survey of mental health nurse practitioners from across the state, the 25 percent reduction in reimbursement has had a serious impact on the financial viability of many NP practices. NPs report that the reduced reimbursements have led to reduced capacity to provide care to mental health clients, significantly longer wait times for appointments, limitations in the types of services available, and some have even reported they are considering clinic closure.

In a state that is already experiencing serious challenges in the provision of mental health services, Regence’s unilateral decision to reduce reimbursement rates simply exacerbates this problem, putting even more pressure on an already stressed system.

Those of us who provide health know that if patients are unable to access care in a clinic or non-hospital setting, some of them will seek care when their illness is much more expensive to treat such as when they are in crisis or, in the case of mental illness, when their behavior intersects with law enforcement. Providing care in the ER or when a patient is in crisis is dramatically more expensive.

Insurers should help ensure that those they cover seek care in the most appropriate and most cost effective setting. Reducing reimbursement for nurse practitioners, creating more barriers to access for patients and refusing to pay the same fee for the same service, is not the way to support patients or to reduce costs.

Susan E. King is the director of the Oregon Nurses Association.