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Therapists decry Blue Cross rate cuts in mental health services

Eagle-Tribune - 11/4/2023

Nov. 4—ANDOVER — Blue Cross Blue Shield of Massachusetts has reduced its rates for several key mental health services, potentially jeopardizing coverage for patients, according to mental health professionals.

"I have been hearing a lot of concerns from members about the decrease in Blue Cross rates on mental health codes," said Dr. Andrea Barnes, director of professional affairs with the Massachusetts Psychological Association. "How could they in good conscience decrease any rates when we have a mental health crisis?"

Codes for therapy are organized into four distinct categories: psychiatric diagnostic interview, psychiatric therapeutic services, family medial psychotherapy and group psychotherapy.

"In the past Blue Cross has actually been in the forefront in paying better than most, which is great and we all appreciated that," psychologist David Rainen said. "In the last few years since COVID, that has changed. Blue Cross is now closer to the bottom of the barrel in terms of rates that they pay and reimbursements."

Rainen said that the codes Blue Cross raised payment for are rarely used. Instead, the payment for intake and one-hour sessions, the two most popular, were both reduced by 2%.

"It was very frustrating to hear this," said therapist Holly Harmon. "It might not seem like a lot of money but when you put that across eight clinicians plus myself it's a pretty hard hit."

Barnes said that at one point, Blue Cross was not paying for 60-minute sessions for a while. This "intimidated and coerced" therapists into using 45-minute session coding so that Blue Cross could then eventually "turn around and say that's the one everyone uses" to justify lowing the payback for a 60-minute session.

"I recognize Blue Cross is a business and they're going to do everything to maximize profits," Rainen said. "But what I think what we'll see happening is pushing people toward (telehealth) companies and push people away from in-person therapy."

Rainen also noted that the major online therapy providers have almost all faced ethical and liability issues in the past.

Barnes called the pay decreases "at odds" with state efforts.

"It hurts everybody when people aren't paid enough," Barnes said. "I don't think Blue Cross cares."

Jeff Bellows, vice president of corporate citizenship and public affairs at Blue Cross Blue Shield, said earlier this month that the organization is continuing "to expand access to high-quality, convenient and affordable mental health care."

"The last three years have been pretty rough on our country," Rainen said. "Add to that that there are not a lot therapists out there. The amount of people being produced with either a master's or doctorate in counseling is being far outpaced by the need."

Rainen said this is especially taking place in New England, adding that anyone who is trying to get into therapy now is facing many challenges with "wait lists you wouldn't believe."

Rainen hired 17 therapists since the onset of the pandemic in hopes of "alleviating the need," but the group still cannot keep up with the demand. He said his practice is busier now than it has ever been.

The average therapist sees between 15 to 20 people a week, Rainen said. Everyone in his practice sees a minimum of 30 people a week.

Barnes said that her psychological group is looking to all avenues. She met with Blue Cross representatives last week but nothing was accomplished. Barnes' group has already consulted with lobbyists, she said. They now are looking at whether there is some course of action with the state's Insurance Department.

Harmon said that she is writing a letter to Blue Cross and is encouraging people in her practice to do so as well.

"It's a skill that's in demand beyond resources," Barnes said. "We're just in this dilemma of what we do about that."

Follow Monica on Twitter at @MonicaSager3


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