Regence Reimbursement Issue

Update from the Washington State Coalition of Mental Health Professionals and Consumers

September 3, 2015

 

 

 

Regence Slashes Reimbursement for Mental Health Providers Again

Seattle, WA (September 3, 2015) Regence BlueShield continues to cut reimbursements to mental health providers. While Regence’s original scheme to cut reimbursement by 30% on October 1, 2015 was rescinded on August 28, a letter went out to providers on August 31 saying that reimbursement for the most commonly used mental health procedure code will be cut by approximately 25% on December 1. This is a huge decrease in compensation for a group of providers that are now earning $.80 less an hour from Regence in real dollars than they were in 2002.

For the most commonly billed psychotherapy service, Regence’s proposed compensation for psychologists and licensed Master’s mental health clinicians would be slashed by nearly 30%, to levels not seen since 2002. Further, the compensation reduction is intended to force MH providers to offer shorter sessions to patients, regardless of patient need.

In a Washington State Coalition of Mental Health Professionals and Consumers survey of mental health clinicians, 75% of 300 clinicians responding said they would or might leave the Regence panel if the original plan had been implemented; the new decrease in reimbursement will likely have the same impact. Many concerns have been expressed by clinicians, the Office of the Insurance Commissioner (OIC), the Washington Psychological Association (WSPA), the Wellspring EAP program and insurance broker Sean Corry about the negative impact this kind of cut would have on access to patients and mental health services.

OIC has already responded to a complaint from WSPA about Regence’s plan to merge two distinct psychotherapy codes into one for reimbursement purposes and in response to OIC’s actions, Regence withdrew its proposed plan. Since the new Regence plan would also lower the most common psychotherapy rate significantly, there is still a likelihood that there will be a large number of mental health clinicians who leave the Regence panel. OIC will be tracking the network adequacy of Regence carefully to make sure that Regence has an adequate mental health network if this plan goes forward.

Kevin Host, Director of Wellspring Employee EAP (Employee Assistance Program), which provides service to nearly 200 employers and covers over 180,000 people, is worried. “Regence’s behavioral health panel is thin already. It is difficult to find paneled licensed clinicians to see patients who need EAP services. It is likely that the most experienced practitioners will leave the Regence panel if a cut of this magnitude goes into effect. We will have an even bigger problem finding qualified practitioners to take cases.”

Sean Corry, a veteran of the mental health parity wars and President of Sprague Israel Giles, an insurance brokerage firm, expresses similar concerns.

“As an insurance broker, my job is to make sure the health plans that clients offer to their employees actually deliver the care that is promised. When a health plan restricts access by severely limiting the number of available mental health providers, that health plan does not get recommended by our firm.”

Regence continues to refuse to meet with mental health clinicians to discuss how their continued effort to reduce payments to clinicians is harming access to mental health care.

Contacts:
Sue Wiedenfeld, PhD, swiedenfeld@me.com, 206-930-2343
Laura Groshong, LICSW, lwgroshong@comcast.net, 206-524-3690
Sean Corry, sean.corry@SIGinsures.com, 206-957-7070


Do you have questions about the codes? Please reference the APA's online Crosswalk of 2012 Psychotherapy CPT® Codes to 2013 or download the PDF.

Thank you to all members for your efforts on behalf of our profession.

Current Procedural Terminology® (CPT) copyright 2011 American Medical Association. All Rights Reserved.