Many counselors have complained about low reimbursement rates from managed care and insurance companies. Some have gone to fee for service payments and abandoned managed care altogether.
Dropping all managed care contracts and only accepting fees paid by clients is one way to handle the problem. Doing that cuts out many clients that have paid into their insurance and expect to be able to use it for counseling. In many demographics, practices would suffer unless our niche occupies the upper end of the income spectrum.
I decided to take matters into my own hands. I called Aetna, Blue Cross/ Blue Shield, Value Options, United Behavioral Health, Magellan, Horizon Behavioral Health, ACI Specialty Benefits, and Oasis Health Care. These are a fairly good representative sample of managed care and insurance companies. All of their provider relations people assured me they were not planning to reduce fees. I politely asked each one if there was a way to get an increase in reimbursement. After some negotiations, Aetna offered me a12% increase, Value Options made no promises but said they are reviewing an increase possibility across the country next year, UBH said they will consider an increase for me when I send a request in writing outlining the reasons, Magellan will also be reviewing an increase in rates. Horizon offered me an increase from $65 to $70, ACI gave me a raise from $60 to $67, and Oasis will give me a $5 raise to $70 EAP and $75 on regular managed care.
PSCHOTHARAPY FINACES writes that the companies they contacted report they will not deal with national organizations like APA, NASW, and ACA. Here is why it has to be an individual, grass roots movement. First, IT WORKED! I negotiated and got increases. Second, if hundreds of counselors call managed care provider relations, they may not get an increase, but the managed care and insurance companies will certainly get the message that we are in need of better reimbursement. One call came to me from a counselor suggesting a class action lawsuit or maybe our national organizations raising hell with the companies. We have found, and have proven, that polite inquiry and persistence works better. The list of the largest managed care and insurance companies is available at ACA’s website http://www.counseling.org/Counselors/PrivatePracticePointers.aspx.
DO IT! Call your managed care companies and ask. Remember, we encourage our clients to take a risk to improve, shouldn’t we? Please consider blogging your experiences with your managed care contracts, bad and good.
Norm Dasenbrook and Bob Walsh are counselors in private practice, consultants, and authors (www.counseling-privatepractice.com)