Therapy patients stop treatment after ‘pre-payment reviews’ swell
by Jeanne Pinder
September 10, 2024
A number of psychotherapy patients in the Northeast have stopped treatment because their insurer, UnitedHealthcare, is requiring substantial paperwork for what it calls a “pre-payment review” that has stopped reimbursements, therapists say.
The interruption in treatment comes after UnitedHealthcare’s Optum subsidiary began subjecting thousands of payments to a “pre-payment audit” in the last several months, the therapists say. After the visit takes place, the out-of-network psychiatrist or therapist is paid by the patient (usually) and the patient submits the bill for reimbursement, to UnitedHealthcare. But Optum, the subsidiary managing health services for UnitedHealthcare, sends a letter to clinician and patient saying it wants detailed records for a “pre-payment review” before sending money. No reason is given. (Our earlier post here.)
“The impact of these reviews is raising concerns about delays in treatment (since many pts are holding off on additional sessions out of fear that the treatment will not be covered), patient privacy, delays in reimbursement, and unnecessary additional administrative burdens on psychologists,” wrote Dr. Jax Gallios, an out-of-network psychologist in New Jersey who submits bills to United on behalf of some of her patients. “It is also raising parity concerns, including further constriction of the already difficult access to mental health care through insurance.”
Gallios said “people STILL haven’t heard back after submitting records for the massive influx of pre-payment review requests — they have up to 45 days to respond to providers after documents have been mailed. I personally haven’t heard either.”
‘Very destructive’
June Feder, a psychologist practicing in Manhattan who is chair of the New York State Psychological Association insurance committee, said others are stopping too.
“Some have notified psychologists they cannot continue treatment because they are not getting reimbursements,” she said in a phone interview. “It’s very destructive.”
A Connecticut psychologist who spoke on condition of anonymity said she also has a patient who is pausing treatment, though she told the patient “I don’t think it’s best” to stop.
It’s not only patients cutting back, but also clinicians.
A West Coast therapist wrote: “I’ve had to reduce my schedule to 60% capacity” to meet the administrative burden. He said he had received dozens of record requests, followed by dozens of duplicate requests.
“Each new request takes 55 minutes to process, and each duplicate 22.5 minutes,” he wrote.
Reports are anecdotal so it’s hard to say how many patients and therapists have quit or cut back. But if patients who paid for services expecting insurance reimbursement are not getting paid (at least one has not been paid since May) and clinicians submitting bills and expecting payment are not getting paid, then it is easy to see how things might shut down.
Other billing challenges
For patients and clinicians, the context of the payment delays also matters. “The thing that I want to underline is that this is coming on the heels of what has been a very difficult period,” said Dr. Marnie Shanbhag, a Florida licensed psychologist who is the American Psychological Association’s senior director of the office of independent practice. “We have not seen demand for mental health services let up since the pandemic, when the demand really did soar. I think we we all understand that people were very stressed out during that period and and are still coping with the fallout.”
The payment delays are particularly damaging to therapists because of the…
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