Anthem agrees to reprocess 28,000 claims to mental health providers

Anthem Health Plans has agreed to reprocess 28,000 claims amounting to $400,000 in additional payments to mental health providers following an investigation by the state Department of Insurance, the department announced Wednesday.

However, it is unlikely that the agreement will prompt physicians' groups to withdraw a discrimination lawsuit against Anthem on the same issue any time soon.

"We're very cautious about whether this really is the "fix" that Anthem purports it to be. We're not sure that it is," said attorney Maria Pepe VanDerLaan, who represents the plaintiffs.

Several weeks ago, the state Insurance Department began investigating customer concerns and a formal complaint from mental health providers about the way Anthem was reimbursing behavioral health claims.

"We had concerns based upon the way the company was implementing codes for reimbursements for mental health claims," state Insurance Commissioner Thomas B. Leonardi said.

Anthem had adjusted its billing codes and fees as of Jan. 1 when a new set of codes established by the American Medical Association took effect.

As a result of the investigation, the insurance department asked Anthem to go back and revisit its method for reimbursing and make proper adjustments for claims dating back to Jan. 1. The company came up with a remediation plan to retroactively reprocess the claims, Leonardi said.
"The company was very cooperative," Leonardi said. "We had no concerns about their cooperation level. We did not have to take any formal action."

Anthem, in a statement Wednesday, said it is making certain adjustments in its new fee schedule in close cooperation with the department and with input from the attorney general's office.

"Anthem Blue Cross and Blue Shield would like to first and foremost assure our members and participating providers that Anthem continues to cover all behavioral health services, including psychotherapy, in accordance with our members' health benefit plans," the statement said.
The insurance department will continue to monitor the plan going forward and has asked Anthem to provide monthly progress reports, Leonardi said.

Despite the agreement, there are no plans to withdraw a lawsuit filed in federal court April 10 claiming that Anthem discriminates against mental health patients. In the suit, the Connecticut Psychiatric Society, the American Psychiatric Association and the Connecticut Council of Child and Adolescent Psychiatry allege that the insurance company used changes in the codes to lower fees paid to psychiatrists.
VanDerLaan said the press release from the insurance department is very vague and relates only to Connecticut.

"From our perspective, the issue is one of parity or ending discrimination in terms of how insurers treat mental health benefits as opposed to non-mental health benefits," she said.

"This is a matter of national concern," VanDerLaan said, "and frankly we are very disappointed that the insurance department didn't reach out to anyone on our side to ask if we believe parity is being achieved here," she said.

In a press release, the plaintiffs have asked Anthem CEO David Fusco to provide more answers about the agreement, including how Anthem determined the number of claims and amount to be paid and whether Anthem will revisit this issue in other states.

Anthem spokeswoman Sarah Yeager declined to comment on the lawsuit, saying the company does not comment on pending litigation.
 

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