Connecticut Mental Health Providers File Complaint Against Anthem

CONNECTICUT — The Mental Health Clinicians Action Network of Connecticut (MHCAN-CT) sent a formal letter of complaint to state Insurance Commissioner Andrew N. Mais Friday, claiming continued poor service by Anthem Blue Cross/Blue Shield.

The letter cited five specific complaints against the health insurance provider:

1. Poor reimbursement rates and concern about reduced rates for teletherapy - Anthem has not increased reimbursement rates in well over a decade, despite multiple requests by many providers over time. Anthem is the lowest paying insurer in Connecticut. Anthem has historically reimbursed at a lower rate for telehealth, and is looking to resume this practice.
2. Poor customer service - Clinicians report routine 60-minute wait times when calling for claims or benefits, and the vast majority of clinicians report they receive inaccurate or incomplete information when they do connect with a representative. It is not uncommon for clinicians to not be able to connect with a representative at all. Clinicians report that Availity (Anthem’s online claims and benefits program) is generally unreliable and incomplete and Anthem’s new chat program is basically unusable.
3. Claims processing times - Clinicians often wait for at least 2-3 months for claims to be processed, and sometimes 6 months or more for claims to be reprocessed when necessary.
4. Number of claims denials - Clinicians routinely report claims denials for incorrect or obscure reasons and extreme difficulty in having claims reprocessed.
5. Number of recoupments/clawbacks - More than one third of clinicians report recoupments, often months/years following the session(s) in question, and many times for incorrect or obscure reasons.

MHCAN-CT represents 456 Connecticut mental health clinicians statewide. The group claims due to the difficulties with Anthem, "83 percent of clinicians with Anthem contracts have either recently ended their contracts or are considering leaving the panel. This will create an unimaginable shortage of services in a time where the demand and need for mental health services has increased exponentially. We and others have repeatedly called on Anthem to address each of these issues in a meaningful way, and are appealing to the Insurance Commission due to our inability to achieve any kind of resolution to date."

The letter to the commissioner also included results of a provider survey, and comments from more than 190 respondents. The complete letter and information may be found here.

According to its website, MHCAN-CT consists of "five friends who all work in various aspects of private practice as mental health professionals in the State of Connecticut. Because of our positions as business owners, clinicians, advocates, and political activists, we have unified our efforts to streamline the communication between our five disciplines as well as our state's legislative bodies, the media, clients, insurance companies, and of course, other mental health professionals."

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