BCBSFL Wrong To Cut Mental Health Providers

A recent story in Health News Florida broke the news that Blue Cross and Blue Shield of Florida (BCBSFL) has notified all of its participating mental health providers that their contracts are being terminated as of November.

Those who wish to continue to see BCBSFL patients will have to sign a contract with a new provider partially owned by Blue Cross and Blue Shield.  Their payments will be cut between 25% and 55%.

BCBSFL’s notice caused a justifiable uproar – one that may extend beyond the boundaries of the state. 

Mental health advocates see the action as a violation of the federal Mental Health Parity Act, because only mental health providers have been singled out.

Florida residents are also concerned.  BCBSFL has four million members, and insures over 7 million people in the state.  They all may lose access to providers as a result of this action. 

But up to 80 million on Blue Cross Blue Shield plans outside of Florida will also be affected.  Blue Cross Blue Shield plans around the country use one another’s provider networks.  Florida’s providers who are dropped by BCBSFL are also automatically dropped from every out-of-state Blue Cross Blue Shield plan, too.

There is a nagging sense that what is behind the BCBSFL decision is a desire to deny coverage for mental illness by denying the people it insures access to mental health providers.

Providers are already forced to accept low BCBSFL rates when they treat patients.   I have a recent statement indicating that a Florida provider gets $51.97 from Blue Cross and Blue Shield for an hour of counseling.

This may seem like a lot of money, but it is not.  At that rate, a provider would have to treat seven patients per day, five days per week, fifty weeks per year, to gross $91,000 per year.  But office expenses, the cost of help, taxes, and insurance would all have to come from this, leaving the provider with a salary of perhaps $50,000.

And BCBSFL thinks this is too generous?

In the interest of accuracy, I should point out that the provider in question is an out-of-network provider who nevertheless handles the BCBSFL paperwork and accepts the payment on behalf of the patient – relieving the patient of this headache.  Also, the $51.97 payment wasn’t even made by BCBSFL, but by an out-of-state plan.  I contacted the out-of-state plan, and its representative confirmed that it paid the rate set by BCBSFL.

If this is the BCBSFL standard, then we pay plumbers, electricians, carpenters, and auto mechanics more than BCBSFL pays mental health professionals.

Is our mental health care really worth less than our clogged kitchen sinks, our burned-out fluorescent lights, our broken porch railings, and our regular oil changes?  BCBSFL seems to think so.

BCBSFL could make the argument that it pays only a portion of the mental health provider’s bill, and the patient co-pay makes up the difference.  Fair enough.  So I added in the co-pay and the provider’s reimbursement went up to $64.

This is still less than we pay carpenters, plumbers, electricians, and auto mechanics.

The cost of mental illness in America is staggering, but it is not because of high counseling rates paid to psychologists.  Using current research, Mental Health America has argued that the economic costs of mental illness are now in the vicinity of $200 billion per year.  In addition, mental illnesses cost over $57 billion a year to treat, making mental illness the third most costly chronic condition.

But, according to a recent article in the New England Journal of Medicine, private insurance pays for only 27% of our nation’s mental health costs (versus 37% of all health costs), leaving almost three-quarters of the mental health bill for federal, state, and local governments. 

Not bad for a country which continues to believe that it’s not paying for mostly single-payer, government-sponsored, national health insurance.

Poor coverage for mental illness is one of the reasons that states have had to mandate mental health benefits.  It is also a reason why Congress passed the Mental Health Parity Act and put consumer protections into the Affordable Care Act. 

But in a state like Florida, where both the Governor and the Insurance Commissioner have repeatedly opposed the interests of consumers, BCBSFL may not be held accountable.  This is unfair and wrong. 

It is also the best argument I can think of for why we need a government that is willing to stand up to private insurers on behalf of its citizens.

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