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R.I. psychologists
unhappy with
UnitedHealthcare contract
(July 2005
Issue)
By Elinor Nelson
Rhode Island psychologists still claim to have not received official
notices from UnitedHealthcare regarding the nuts and bolts of the
state's transition from Blue Cross/Blue Shield of R.I. to United
for health care services to state workers, retirees and their families.
And UnitedHealthcare claims to have furnished all of the information
a psychologist could reasonably expect to get from an insurance
company making the transition. Unfortunately, it looks like business
as usual between R.I.'s psychologists and United.
The problem stems from UnitedHealthcare winning the new contract,
which was implemented on May 1, 2005. United's mental health reimbursement
rates had been substantially less than Blue Cross Blue Shield's
and although the company raised its rates in March, the payments
still fall short of the resource-based relative value scale offered
by Medicare. The Medicare rates are viewed as minimum wage for practitioners,
according to Peter Oppenheimer, Ph.D., legislative/managed care
liaison for the R.I. Psychological Association (RIPA).
Providence psychologist Robert Pressman, Ph.D., who has written
several books on practice management, has compiled data showing
that United pays from $17 to $55 less per patient than Blue Cross
Blue Shield, with an average underpayment of $35 per patient. He
suggests that an average of three weekly state patient contacts
per practitioner could amount to a $105 weekly loss per practitioner.
So although sticking points remain regarding the communications
from United, "in terms of the many issues, the biggest is reimbursement,"
states Pressman.
Nevertheless, while Oppenheimer says that he has gotten answers
to some of the questions he asks on behalf of RIPA membership, it's
been "chasing information from them instead of them broadcasting
policies. It shouldn't be up to the association to be the communicator
of their procedures." Questions remain, he says, about numbers of
sessions permitted and where to send claim forms, because United
has many locations.
Peter Erickson, Ph.D., president of RIPA, adds that although it
is his understanding that no preauthorization is required for patients
covered by the state contract (this has been confirmed by United
officials), preauthorization is required for other United clients.
He says that he has not received an official communication from
United stating this important fact. Yet, United says that it did
send a letter to its providers that includes this information.
Additionally, although the contract states that for the first six
months out-of-network psychologists seeing patients may bill United
for their full fee minus the patient's copay, and that after six
months patients choosing to see out-of-network providers may submit
claims to United and receive an out-of-network provider reimbursement
payment, this information has not been communicated to R.I.'s psychologists.
Debora Spano, United's regional public relations director, responds
that recruitment letters went out to all providers in R.I. on March
21. The letter explains that United is the new managed behavioral
health vendor and states that no pre-authorization is required for
these patients, but it fails to mention the arrangements for out-of-network
psychologists during the first six months or thereafter.
Some psychologists also claim that they or their patients have
encountered poorly trained United staff when calling help lines.
James Curran, Ph.D., RIPA's federal advocate, says that he is an
existing United provider and has not received information from United
about filing claims for these patients. Curran is treating some
patients under this contract who had formerly been seen by non-United
providers. The patients have told him that when they called United
with billing questions, they were informed there was no mental health
coverage. "Clearly they [United] are very confused," says Curran.
Counters United Behavioral Health's Director of Communications
and Public Relations, Ann Fleischauer: "We believe that the contract
installation has been going well." Subscribers, she says, have received
new identification cards, providers have been notified of the increased
rates, new providers are being recruited and United providers can
"reach us through different avenues." Anyone new to the network
receives claim-filing information, she says.
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