Tuesday, January 27, 2009

BCBS's all over the place across the US in terms of pre-author for Mental Health services

Vast amount of confusion as indicated by postings on the Div 42, Independent Practice, of the American Psychological Association, pertaining to BCBS pre-authorization or not.

NC psychologist states that pre-author is being required but it is not clear if this is associated w/ 'federal employees' who have BCBS or BCBSNC across the board.

(Of course if, like me, your family of three pays $750/ month with a $2500 deductibe for anything other than going to the doctor, you don't get mental health benefits except at the 50% vs 80% rate, as you're not in a BCBS group plan).

This post from a mental health provider in Minnesota:

"Although a bit different, BCBS of Minnesota just enacted a similar requirement for Federal plans: they now require a pre-authorization for ANY MH services to be paid, even if you had been seeing the person in 2008. Typically, we got 8 session up front with no questions; we now have toeither call in for a verbal auth # or write a prior to get those first 8sessions. Of course, the announcement of this change came in mail in theform of a letter that looked like junk mail that many providers do not readcarefully. The announcement also was "wrong": it says you must submit IN WRITING, prior to the first session a request (even for people whom you havenever met before); they then retracted the "in writing" requirement with"verbal is ok", but only informed their staff of the change(staff admittedthey too were confused). Some of my colleagues are getting claims denied andwondered why---"you didn't call in"---..."

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