Mental-health groups challenge BCBS, turn to feds
A coalition of 13 mental health groups has asked the federal government to help determine whether Blue Cross & Blue Shield of Florida is breaking a law that prohibits discrimination against the kinds of services they provide.
The move comes after an announcement that the company is terminating contracts for all mental health workers and requiring them to apply to Kansas-based managed care company New Directions Behavioral Health.
Some providers say they won't sign the contract, raising concerns about access to mental health care for BCBS-FL customers.
The Parity Implementation Coalition includes the Betty Ford Center and a branch of the American Psychiatric Association. On Thursday, the group sent letters to BCBS-FL, New Directions and three federal agencies.
The letters make 10 demands, including that BCBS-FL and New Directions be required to release details about their medical and surgical criteria and how they will apply to benefits.
“There is the implication of legal action,” said Stephen Ragusea, a Key West psychologist. “That’s why we’re saying we have to get more information.”
The point is to ensure that the company complies with the Mental Health Parity and Addiction Equity Act, which forbids limits on mental health services that don't apply to other medical treatment.
BCBS-FL spokesman Paul Kluding said the company’s chief medical officer had a discussion with the coalition Tuesday to clarify positions and begin to clear up any misunderstandings.
“We acknowledge the receipt of the letter and are giving it our full attention,” he said.
The New Directions plan would cut reimbursements to providers and forbid them from referring patients to anyone out-of-network, raising concerns about whether the company will maintain an adequate array of mental health providers.
Irvin Muszynski, of the American Psychiatric Association, who wrote the letters, said nobody objects to BCBS-FL contracting out mental health services.
"What’s an issue is the terms of operation," he said.
He said that BCBS-FL appears to acknowledge their concerns and that a revised New Directions contract seems within reach. The Florida Office of Insurance Regulation said it has no jurisdiction over the matter, Muszynski said.
South Florida health attorney Jeff Cohen said the law doesn't require private insurance companies to reveal much, if anything, about their business dealings. The only plans that would be subject to transparency laws are those that operate under government contracts, such as Blue Cross's Medicare Advantage Plan, he said.
Providers who currently have contracts with BCBS-FL say the reimbursements offered from New Directions are lower by 25 to 55 percent. Those who currently have contracts with BCBS-FL will be terminated Nov. 30.
-Reporter Brittany Alana Davis can be reached at 954-239-8968 or by e-mail.