Psychologists Take Issue with Insurers over Reimbursement

The Oregon Psychological Association is trying to resolve the problem amicably

Psychologists find themselves at odds with insurance companies over reimbursement, and, for the first time, the Oregon Psychological Association is taking a pro-active stance.

“It’s getting more and more difficult to get reimbursed when people have serious mental health issues,” Shana Koslofsky, PhD, president of the Oregon Psychological Association, told The Lund Report. Insurers are also delaying payments, sometimes for as long as three or four months.

People who have chronic health conditions are often told they can only see a mental health practitioner for a few sessions, but may need more treatment to deal with serious mental health issues such as posttraumatic stress and pervasive depression disorder.

And, there’s also been a trickle-down effect, with psychologists only able to bill for a 45-minute rather than a 60-mintue session.

It comes down to whether insurers or psychologists should be in charge of determining the treatment a person needs, Koslofsky said, and “insurers seem to fail to recognize our areas of expertise.”

A faculty member at Pacific University, Koslofsky only has a small clinical practice but has been meeting with insurers in an attempt to resolve these problems amicably. She declined to identify the insurers by name.

“We have to go through the process and establish mutually collaborative relationships,” she said. “I want to have a more direct and consistent line of communication so our experience can be more collateral, and we can have a voice.”

Nevertheless other mental health practitioners who have contacted The Lund Report indicate that OPTUM, which handles claims on behalf of United Health and Providence Health has been extremely difficult to deal with and unresponsive to concerns about the need for more intensive treatment. Even though these practitioners have filed appeals, there’s been little or no change. https://www.thelundreport.org/content/moda-health-responds-complaints-ab...

Others are saying that Moda Health has been holding up payments for up to 90 days in violation of the Prompt Payment law.

However, that law doesn’t have jurisdiction over health plans on the insurance exchange, according to Mark Peterson, spokesperson for the Oregon Insurance Division. In this case, insurers can take up to 90 days to pay such claims because people may not have paid their monthly premiums. He cited a federal law that gives insurers additional time to pay claims.

Diane can be reached at [email protected].

News source: