Blue Cross mental health cuts leave some Minnesota clinics struggling
The
But some therapists, like Brecke, saw bigger cuts because the insurer realized last year it had mistakenly been paying them too much. So in addition to resetting the payment rates,
Brecke, who got a bill from
"That is not easy to do when you have your own little business and have to pay expenses," she said.
The impacts are felt mostly by small mental health clinics without the market power to negotiate payment rates and other contract terms. Some are concerned that clinics will shut their doors or stop taking insurance altogether, making it harder or more costly for those needing help for trauma, depression, anxiety, substance abuse and other issues.
"What is probably going to happen is providers will leave the network because they cannot make a living," said
Melek said he is not seeing mental health rate cuts in other states.
"If anything, on a national level I think there is more of a focus on paying behavioral health providers comparably to physical health providers," he said.
A study last fall by Melek and others at Milliman found that insured Minnesotans went out of network for mental health care five times more often compared to out-of-network use of specialty physicians. Because going outside a plan's network often means higher co-payments or coinsurance, the data suggest that the state's mental health insurance networks don't have the capacity to meet service needs.
"Most therapists go into the field because they want to serve all populations," said Brecke. "It shouldn't just be the rich that should have access to good care."
Brecke, whose office is in
"I don't feel like I have any other choice," she said. "I really struggled with trying to decide to keep
Brecke's rates fell so dramatically partly because
The Art of Counseling clinic in
"We are living paycheck to paycheck," said owner
The clinic uses art therapy to help its clients -- many with serious and persistent mental illnesses -- process emotions or deal with trauma.
"This is double whammy. We have been hit both ways," said
"This could result in higher costs for the state of
Disputes over payments
Nearly 50 clinics have turned to
"It is devastating for these small providers," he said. "This is money that has long been spent on overhead and other costs of the practice."
But legally there are few options. The Blue Cross contract with providers stipulates that disputes go through arbitration, with costs shared by both sides. That prevents him from pursuing a class action against the insurer.
Some of Friedemann's clients say they are being asked to pay back too much money.
"A lot of providers say the math is wrong," said Friedemann. He is considering taking at least one case to arbitration, but unlike a court case, an arbitrator's decision does not set precedents for other cases.
In a statement Wednesday,
"The majority of providers affected by this issue have either already submitted payments in full or have agreed to a payment installment plan," the company said.
Complaints have been made to the
But the
"Blue Plus is allowed to recoup overpayments to its providers," the agency said in a statement.
"The
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