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Psychologists’ pay cuts inspire protest to feds

The American Psychological Association is taking aim at Blue Cross & Blue Shield of Florida again — trying to prevent the company from outsourcing its mental health care and cutting payments to providers.

This time the stab comes in the form of a letter to three federal agencies: The U.S. Department of Labor, the U.S. Department of Health and Human Services and the U.S. Department of Treasury.

The letter alleges that BCBS-FL is breaking federal law by terminating its contracts with mental health workers and asking them sign reduced contracts with a company of which it is part owner, Kansas-based New Directions Behavioral Health.

At issue is whether BCBS-FL is violating the federal “Mental Health Parity and Addiction Equity Act” by cutting rates for mental health workers by one-third and not doing the same to other providers.

“We are deeply concerned that if BCBS-FL is allowed to do this, other insurance companies will follow suit and undermine parity through similar cuts,” said psychologist Katherine C. Nordal, of the APA.

The APA, the country's biggest mental health organization, is investigating mental health cuts from five other BCBS-FL companies, she said. The APA will wait to hear a response from government agencies before deciding whether to take legal action, she added.

Department of Health and Human Services spokesman Keith Maley said the agency received the letter, which was sent Oct. 5, and is working to resolve the issue.

A joint e-mail from New Directions and Blue Cross & Blue Shield of Florida defends the change and says that it is not isolated to mental health providers.

“It is important to note that BCBS-FL has undertaken a number of re-contracting efforts as a way to improve quality and address costs,” the letter says.

For instance, the e-mail says, BCBS-FL recently modified changes to home health, home infusion and durable medical equipment providers and asked providers to sign an agreement with an outside company.

South Florida healthcare lawyer Jeff Cohen said insurance companies have been outsourcing all types of services for decades as a way to make money.

In radiology, for example, many companies have outsourced at increasingly low rates for providers.

This isn't even the first time mental health has undergone the switch. For example, the managed-care company United Behavioral Health handles mental health care for United plans.

Connie Galietti, executive director of the Florida Psychological Association, said they're taking up this issue with BCBS-FL now because of "extreme" changes to the contract that include a ban on out-of-network referrals.

"It's such a huge, huge change," she said.

Perhaps the real parity issue, Cohen said, is whether the patients will face co-pays or deductibles that are similar to that of other services under the direct contract model.

There's also concern from mental health groups over whether the shift will turn off so many providers that it will be difficult for patients to access quality care.

“There's a lot of concern about access,” he said.

That's a mantra that has been echoed over and over by mental health workers, even as they turn away BCBS-FL patients and refuse to sign contracts.

The letter from BCBS-FL and New Directions says that the BCBS-FL will still have access to plenty of providers.

Psychologist Stephen Ragusea, of Key West, who said he's not signing, said many patients have also expressed concern that they won't be able to get a good counselor in network.

“Our lawyers, which are some pretty sophisticated Washington DC lawyers, have said that there's a violation of the parity law,” he said.

“What we have to see is whether Kathleen Sebelius (Secretary of HHS) agrees—and if she does agree then if she's willing to accept the heat from insurance companies by enforcing the law.”

---Health News Florida is an independent online publication dedicated to public-service journalism. Reporter Brittany Alana Davis can be reached at 954-239-8968 or by e-mail at