The Psychotherapy Action Network has created an Insurance Toolkit that includes an Insurance Guide and Insurance Tracker. The guide outlines what psychotherapists and patients should know when insurance companies deny or question care, while the tracker aims to document obstacles dealing with insurance and reimbursement.
LINDA MICHAELS; [email protected]
Michaels is a psychologist in private practice and co-founder of the Psychotherapy Action Network.
Michaels told the Institute for Public Accuracy: “The Insurance Toolkit came about because psychotherapists have never-ending problems dealing with the for-profit insurance system we have in this country. Therapists do not get any training in graduate school about how to do any of these administrative tasks––how to interact with insurance companies, how to bill patients and set rates, how to push back if patients get a letter of denial [of care].
“Individual therapists are also not dealing with a daily onslaught of these letters. But every so often, it happens to you. You panic and don’t know what to do, and you need resources. There are other guides out there on what to do. Some group practices have 200-page documents outlining how to deal with insurance, and you have to be a lawyer to understand them.
“I wanted to create something direct and simple: step-by-step instructions on what to do when you get a denial letter from insurance, or a prepayment audit, or any number of things insurance companies come up with [to deny mental health care]. I wanted to give therapists confidence and to send the message that patients need to be involved in these processes too. Some therapists want to protect patients by dealing with the insurance companies themselves. That isn’t helpful: it’s the patient’s insurance policy and the patient’s therapy. Like anything we try to help patients with, therapists want to empower patients to deal with things on their own. That is why I wanted this guide to be a little different from what is already out there.
“The second part of the toolkit is the Insurance Tracker. It is only by documenting the problems out there that we can build legal cases, educate the public and other therapists, and inform advocacy. We have to document these abuses by insurance companies. In the past, we had a Google form that asked therapists to document their problems with mental health insurance parity. We got a really rich dataset from that and wrote up a lengthy letter to the Department of Labor [that was used when the DOL issued a request for comment on mental health parity rules]. The DOL incorporated that information into their rules on parity, though the Trump administration has unfortunately stopped that entire effort, because the insurance companies sued. That is a huge stepback. The government doesn’t stand up to the companies and enforce the rules.”
Psychotherapy Action Network research was also used in Illinois in House Bill 1085, which passed the state House by an overwhelming majority in late October. HB 1085 impacts insurance policies regulated by the state of Illinois. Michaels wrote: “that legislation increases reimbursements to therapists, pays for therapy provided by pre-licensed clinicians, protects billing for 90837 [60-minute psychotherapy], and speeds up credentialing. These are positive changes in the right direction––and hopefully we will see clear improvements and any necessary enforcement to hold insurers accountable.”
Michaels told the Institute for Public Accuracy: “We can use this documentation to get things into media, to inform specific advocacy, and to write legislation to fix the problems––like in Illinois. It’s better to use legislation to fix the problems than to let the insurance companies create ‘corporate solutions.’”