Mental Health Claims Being Denied? This May Be Why

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mental health, mental health coverage, mental health insuranceHaving trouble accessing psychotherapy? NBC reported this week on some news that may explain why.

On January 1st some of the coding that providers use to bill for mental health treatment were changed. Unfortunately, many payers — including private health insurers and government programs like Medicaid — hadn’t changed their systems yet, so the systems are seeing the new codes as incorrect. This means many mental health professionals are getting their claims denied and not receiving payment.

Here’s what NBC is reporting:

“… systemwide delays and outright denials of payment could last for months, jeopardizing not just the nation’s 500,000 [mental health] providers, but also access to care for millions of mentally ill Americans …

How long the denials and delays may last is anyone’s guess. Medicare officials say they’ve begun reprocessing claims that were denied in the first weeks of the year. But for some Medicaid programs, the problem is so complex that they may not be able to get up to speed to process claims until June, experts tell NBC News …

Still, some providers may stop participating in insurance plans that delay too long, or cut fees, and others might be forced to close shop entirely, unable to go for weeks or months without income.”

Photo credit: © Stuart Miles – Fotolia.com

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About Katherine Stone

is the founder & editor of Postpartum Progress. She was named one of the ten most influential mom bloggers of 2011, a WebMD Health Hero and one of the top 25 parent bloggers using social media for social good. She also writes the Fierce Blog, and a parenting column for Disney's Babble.com.

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  1. IDK…I’m a great advocate for helping people access mental health care. I stay on insurance panels because of my ideals, when so many of my peers have pulled off of them. In the wake of Newtown and with so many people and blogs advocating for better access to #mentalhealth care, it seems that the health insurance system could try to be more responsive to societal needs. Mental health provider pay-outs have NOT increased in BC/BS NJ system for 25 YEARS. Many of my January claims, even tho they have the correct coding, were rejected and I had to take my time and call them in one by one, then wait for the claims to be reprocessed before I got paid for work I did weeks ago. My rent, electricity, insurance, mortgage & food bills don’t wait. And the psychotherapy groups are forbidden by law to lobby the insurance companies. WTF?

  2. I too am experiencing many issues with the health insurance industry. They have used the new codes as an excuse to yet again lower the fees and make it very difficult to submit the correct codes for what we actually do in treatment. I am sure there are a lot of politics behind the new codes. But I am trying very hard to jump through the hoops and not deny care to anyone. It is very frustrating and I understand why many of my colleagues are dropping out of panels and going fee for service only. It has made me question my ability and desire to stay in private practice and still do my own billing to keep my costs down.

    When we give a vital service, are treated like a money monger, and get less than your local plumber, it is a struggle. We doubt our own value. Yet, I don’t treat colds, I treat people, women fighting for their own value and sanity. They are the foundation of our future. We need to invest in them. Stepping down from the soap box!

  3. Hi Karen – I too feel your frustrations and hear what you are saying. I agree we perform a vital service, yet get treated like money mongers and get paid like baristas (no disparaging baristas but they don’t need to do a 5000 hour internship). Women & families need professional help and the safety net is just about non-existent.