The Massachusetts Psychological Association and the Massachusetts Neuropsychological Society have a long history of engaging with different insurance companies to advocate for practitioners, according to Roger F. Cohen, Ph.D., former member of the MPA/MNS Joint Advocacy Group.
Cohen explained that the MPA and MNS together have done some “pivotal work” since the 1980s with a variety of insurers, including Tufts, United Healthcare and Blue Cross. “MPA and MNS joined together around issues of mutual concern,” he said.
Collaboratively MPA and MNS have attempted to inform various insurers of the importance of neuropsychological testing and assessments. “Neuropsychological services have great potential value. They contribute to the differential diagnosis for patients with acquired or neurologically based issues,” Cohen said. “Clinical research is the basis for making a case for the usefulness of the services.”
The two organizations have also worked with insurers to set criteria on policy and procedure regarding testing and assessments and prior authorization, according to Cohen. “We’ve struggled with insurers to get a sufficient number of hours to do the job needed to provide what’s medically necessary for the patient,” he added, noting that such obstacles are the reason many providers drop out or never join insurance panels.
Most recently, these joint efforts have focused on discussions with Beacon Health Options, specifically regarding provider enrollment and claims issues. MPA/MNS began meeting regularly in person and by phone with Beacon in May 2013.
These meetings have produced some positive outcomes. Cohen said, “[Beacon has] been fair-minded, reasonable people, open to and prepared to develop mutually respectful relationships. They acknowledged customer service and provider relation issues in the past and have guaranteed to change them.”
Cohen explained that, in the past, reaching the appropriate person to answer questions at Beacon had posed a challenge. “Beacon came to appreciate issues facing psychologists and neuropsychologists were more complicated than [those] psychiatrists and social workers had,” he said.
“They put in place an arrangement whereby when a neuropsychologist or psychologist calls with a question, staff would redirect the call to one of the psychologists heading up the effort. They understand the complexity of the issues and can handle them.”
Additionally, Beacon has recognized the sensibility of removing prior authorization and making appropriate CPT codes available to its providers, according to Cohen.
He explained that neuropsychological assessments comprise three parts: the initial clinical interviews; testing and number of hours involved; and meeting with patients and/or family to review the conclusions. “Neuropsychological work requires time, clinical interviewing, equipment and test materials and can run into thousands of dollars. It’s a technically intensive enterprise,” Cohen said.
In some cases, a medical condition might also be part of the patient profile. “Beacon took action where it could and agreed to make the appropriate codes available for clinical patients,” Cohen said.
“These codes allow the neuropsychologist and psychologist to participate fully in medical and mental health care. Beacon has generously advocated with their medical partners to make the codes available so we can be paid for the work we do.”
Multiple attempts to reach Beacon Health Options for comment were unsuccessful.
By Phyllis Hanlon