Broad View: August

Michael_RBy: Michael Ranney, MPA, OPA Executive Director

Insurance advocacy on behalf of OPA members is a part of our daily routine and a top priority for OPA. Bobbie Celeste and/or I hear from OPA members all the time. Some days it is almost impossible to get Bobbie off the phone as she handles one call after another. We also monitor the listserv for discussions about issues that people are having with insurance. Back channel follow-up helps us get the details to try to intervene to resolve issues. Just when we get one problem with one insurer resolved we get a new problem with a different insurer to address. Throw in a few Medicare problems, some of which seem to drag on forever and we’ve got lots of balls in the air. All of this work is probably not obvious. We often have so much going on that there isn’t much time to talk about it. People we help may thank us personally but don’t usually broadcast their appreciation and satisfaction.

The answer to many insurance issues is at the federal level. We keep APA informed of the problems our members are having and the tactics that insurers are using. We work closely with APA, at least on a weekly basis, if not more frequently. Our main initiative with them at the moment is with regard to Humana/Life Synch.

The main focus of many of our conversations is the possible parity violations. To try to get more data on this APA is asking for our help. Here is the message from APA:

Take a brief survey to further parity advocacy by the APA Practice Organization

As part of its advocacy for equitable access to mental health care, the APA Practice Organization is conducting a brief survey about potential insurance company violations of the Mental Health Parity and Addiction Equality Act (MHPAEA. We ask you to complete the following survey to help us identify offending practices and companies, as well as whether patients have been improperly denied care. The survey should take about 10 minutes.

We are particularly interested in responses from psychologists who are willing to let us contact them if they have fact patterns of particular concern to us. (The brief survey format does not always give us the key picture that we need)

APAPO is particularly concerned about company practices that you believe have significantly harmed patients their care, for example by terminating or stepping down care too early. The focus is on health plans that are subject to federal parity under MHPAEA (not plans covering fewer than 50-employees or state or public school employee plans that have opted out of parity). Take the survey.

(If you have already completed this survey in response to a May 30th, article in APAPO’s Practice Update e-newsletter, thank you and please disregard this message.)

Our very helpful contact at Anthem, psychologist Dr. Peter Ambrose, Regional Vice President for Medical Management for Wellpoint, is leaving Anthem (budget cuts). Peter and his team have always been responsive and helpful. He made himself available to participate in our Insurance Committee meetings periodically to discuss questions and concerns and has presented at OPA Conventions. We didn’t always like the answers we received but at least we got answers. Peter has put us in touch with some new contacts and we have already followed up with them. We are hoping to maintain the same type of helpful relationship.

Medicare issues continue. Bobbie and I both are working on several cases right now. Bobbie will be reporting on a meeting she attended recently with key Medicare staff. I recently attended the Ohio Part B Advisory Group Meeting. These quarterly meetings are a good opportunity to raise issues that OPA members are having. One helpful resource Medicare providers may want to consult is available on the CGS website. This shows the schedule for “Ask the Contractor Teleconferences.” You will see that there is one coming up on “Preparing for the ICD-10.” They also host webinars and workshops. Click on FAQs to get CMS responses to questions you may have.

OPA has your back when it comes to insurance issues. Keep us informed of problems you are having so that we can fight for you. Post on the listserv or email me directly.

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