Sara Jasper, JD
Staff Attorney
The Therapist
January/February 2015

On October 16, 2014, CAMFT sent a Managed Care Survey to all of its 15,049 clinical members. The survey came about as a result of a specific request for data from other members of the Department of Managed Health Care's quaterly Consumer-Provider-Plan-Agency (CPPA) mental health work group of which CAMFT is a part.

The survey consisted of 17 questions. Less than 1%, or 746, of CAMFT’s Clinical members responded. The results of the survey revealed the following:

• Thirty-six percent of the providers who responded indicated that managed health care plans occasionally place limits on the number of therapy sessions.
• Twenty-one percent indicated that plans frequently capped the number of covered sessions available to clients. Magellan, UBH, Blue Shield, MHN, and Anthem Blue Cross were cited as the plans that limit the number of treatment sessions.
• Twenty-nine percent of providers reported being required to get reauthorizations for treatment of a patient every six months.
• Twenty-five percent reported that the plans they work with never require reauthorizations. According to members, Anthem Blue Cross, Blue Shield, Magellan, MHN, and UBH are the plans that most frequently require reauthorizations.
• Forty-one percent of respondents indicated they have discontinued working with a managed care plan due to a reduction of the customary reimbursement fee. Other common reasons for terminating relationships with managed care plans include burdensome paperwork and delays in reimbursement.
• When asked if they had been denied reimbursement by a client’s out-of-state plan because of the providers’ MFT license, 71 % of respondents indicated they have not been denied reimbursement for this reason. Providers also stated that Anthem Blue Cross and Blue Shield have denied their out-of-state claims on the basis that they were licensed as an MFT.
• Fifty-one percent of respondents indicated they are never audited by the managed care plans they work with. According to the survey responses, audit requests most frequently come from UBH, Magellan, Blue Shield, and Anthem Blue Cross.
• Sixty percent of respondents indicated they have not received more claim denials since the implementation of the Affordable Care Act.
• Of the 15% who have experienced an increase in claim denials, the reasons for those denials are most often “sent to wrong claims address,” “incorrect CPT Code,” and “claims being handwritten.”
• When asked how many requests for refunds of overpayment they have received within the past 12 months, 34 percent of respondents indicated they have received between 1 and 5 requests. The managed care plans that most frequently request refunds of overpayment include Anthem Blue Cross, Blue Shield, UBH, and MHN.
• Within the past two years, 173 of the respondents requested an increase in their rate of reimbursement from the plans they work with. Fifty-seven of those respondents received an increase. Those who were successful believe their success stemmed from persistence, having worked with the plans for a number of years, and having trained in a niche area of psychotherapy.

How Results of the Survey Will Be Used
As many members have pointed out, there are a multitude of concerns to discuss and address in regard to managed care. This survey was a follow-up to a similar survey that was completed by clinical members in 2009 (see Catherine Atkins’s article, “CAMFT Members Give Their Opinion of Managed Health Care Plans”). The idea for this type of survey came about as a result of a specific request for data from other members of the CPPA mental health work group of which CAMFT is a part. Those who also took the survey in 2009 may notice the survey is largely unchanged, with the exception of a few additional questions. CAMFT thought it wise to revisit some of these questions to see if issues with plans have been resolved. We also added a few more questions related to issues brought to CAMFT’s attention that may be of interest to the CPPA work group.

The results of this limited and specifically focused survey will be used to inform the work of the CPPA group going forward. The results will also help CAMFT determine which issues cannot be resolved through the CPPA and may be more appropriately addressed through legislation. Although the results of the survey will be shared with representatives of the insurance plans who participate in the CPPA meetings, the survey is anonymous and cannot be used against CAMFT members who respond.

During the December 2014 Board meeting, the Board approved the creation of an Insurance and Healthcare Reform Committee. The ideas/suggestions you provide regarding questions to be included in future managed care surveys are being collected and will ultimately be shared with the members of this Committee.

Sara Jasper, JD, is a staff attorney for CAMFT. Sara is available to answer member calls regarding legal, ethical, and licensure issues.