30,000 patients suddenly lose their psychiatrists and therapists in one state....

[vistaril]

One of the largest private groups in the entire country(11 offices and 30,000 patients) has just announced they are shutting down, effectively immediately.

Why?

Blue cross(which is one of the dominant players in this state of Alabama) just elected to cut back, slashing some services and slashing funding for others. With these cuts, the practices were no longer financially feasible. There is no transition period- the doors are being shuttered and appts canceled.

doesn't really matter to me because I don't work for them or have any contracts with them and won't be in this state much longer, but it affects a bunch of people I know. And patients.

Now some of these patients will obtain access eventually with another psychiatrist or practice. And Im sure some of the providers at this group(Alabama psychiatric services) will spin off into their own smaller groups and try to renegotiate whatever they can with Blue cross....but no doubt blue cross holds the hammer here and will cream them.

I don't think we have any/many Alabama posters here, but this is not a phenomenon that is unique to Alabama. I guarantee you that if blue cross execs in Alabama can sit around and devise a way to crush psych reimbursements there and send a major player into their grave, then blue cross execs in Georgia and Florida and texas can do the same thing. Or whatever insurers with large market shares in name the state.....

The future for insurance based outpatient care in mental health looks bleaker by the day.

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[wannabie]

That's terrible for practitioners and patients. Why are physicians in general bad at banding together to stand up to the tyranny of insurance companies? I know there are some limitations placed collusion laws, but it seems to me that physicians are pretty impotent on these issues. Is there any reading material out there on these sort of issues?

 

[vistaril]

That's terrible for practitioners and patients. Why are physicians in general bad at banding together to stand up to the tyranny of insurance companies? I know there are some limitations placed collusion laws, but it seems to me that physicians are pretty impotent on these issues. Is there any reading material out there on these sort of issues?

I think in this case, by banding together(it's a massive group....literally 40 or so psychiatrists, maybe more) they simply were seen as ducks lined up perfectly to be gunned down by the insurance company. There isn't any doubt in my mind the goal of blue cross here was to fracture and disrupt care to reduce overall costs. Sure, some of these patients will pursue outpt psych care elsewhere on BC's dime, but some won't(and that's savings right there). And you can bet that when the splinter groups come to BC trying to renegotiate these contracts blue cross has them totally bent over, so they will save some on the new contracts(probably offer them even less than what APS bailed on with the lowball offer).......basically, what blue cross is attempting to do here is take outpt psych off the insurance table completely. And make it similar to massage or non-medical acupuncture or something.

this is a MAJOR win for the insurance industry against your everyday mh care provider, and it's most definitely going to spill over. You can bet that blue cross execs in other states will use this as a model for the near future.

 

[Baller MD]

I thought psychiatry is becoming more respected?

 

[F0nzie]

Whoa. Any idea how much blue cross was paying them for 99214s?

 

[F0nzie]

I thought psychiatry is becoming more respected?

I am thinking the financial incentives outweigh the respect here. Bcbs is competing with a bunch of other insurance companies for competitive rates. MH services are a selling point to maybe 1 in 10 clients or less?

I feel the rules would probably apply to any specialty where insurance feels they can cut corners without getting in trouble. Psych is a big fat target.

 

[vistaril]

I am thinking the financial incentives outweigh the respect here. Bcbs is competing with a bunch of other insurance companies for competitive rates. MH services are a selling point to maybe 1 in 10 clients or less?

I feel the rules would probably apply to any specialty where insurance feels they can cut corners without getting in trouble. Psych is a big fat target.

yep.....and the reality is paying customers DONT shop for insurance based on how great the psych coverage is. The vast majority don't care.

With things like obgyn, cards, ent, etc.....oh boy the insurers know that they can't lose all those in network providers or there will be hell to pay.

What bcbs just did here was basically give a big FU to psychiatry.....and they will make money off of the move and not suffer any consequences.

 

[vistaril]

Whoa. Any idea how much blue cross was paying them for 99214s?

I don't have the exact number(I'm not an insider in terms of that group), but I do know the average full time outpt psychiatrist did ok there. It was your typical M-F med mgt deal at the main office and salaries were decent(200-240k for full time work). but they did decent pt volume to get that.

 

[Ceke2002]

There's an article about this on al dot com. I seriously cannot wrap my head around such blatant disregard for the safety and well being of people with mental health issues over what seems like little more than an exercise in money grabbing. Just, holy effin WOW!

http://www.al.com/opinion/index.ssf/2015/02/alabama_facing_a_huge_mental_h.html

 

[F0nzie]

They must have been operating on very tight margins and this was the final nail in the coffin.

 

[vistaril]

They must have been operating on very tight margins and this was the final nail in the coffin.

I mean they were doing ok before....no real better or worse than most other routine med mgt outpt outfits. If you saw enough patients you did ok I guess.

I talked to one of the psychs from there today at the main office, And he said blue cross just totally sh$t on them. Changed the contract to something that there was NO WAY that anyone could take. They basically cancelled the contract intentionally. So this doesn't appear to have been a straw that broke the camels back type thing....more like a "we aren't going to pay for outpt mental health anymore for these 30000 patients and watch this....."

This sort of major power play has legs....and is going to travel.

 

[vistaril]

There's an article about this on al dot com. I seriously cannot wrap my head around such blatant disregard for the safety and well being of people with mental health issues over what seems like little more than an exercise in money grabbing. Just, holy effin WOW!

http://www.al.com/opinion/index.ssf/2015/02/alabama_facing_a_huge_mental_h.html

Ummm that's what insurance companies are in the business of doing-making money. The risk for blue cross when they do something like this is will it affect their reputation so much amongst employers and customers that it's not worth the savings. And since most people don't care, the answer is no....

 

[Ceke2002]

Ummm that's what insurance companies are in the business of doing-making money. The risk for blue cross when they do something like this is will it affect their reputation so much amongst employers and customers that it's not worth the savings. And since most people don't care, the answer is no....

Just seems to me, from a non US point of view, that there's a fairly big difference between an insurance company being run effectively to both turn a decent profit and provide proper benefits to its consumers, and one that seems to be screwing a segment of its consumers over for the sake of greed.

 

[splik]

Just seems to me, from a non US point of view, that there's a fairly big difference between an insurance company being run effectively to both turn a decent profit and provide proper benefits to its consumers, and one that seems to be screwing a segment of its consumers over for the sake of greed.

are there any other countries in the world where there are for-profit health insurance companies? I don't think so. Even Saddam Hussein provided free healthcare to all Iraqis.

 

[erg923]

Just seems to me, from a non US point of view, that there's a fairly big difference between an insurance company being run effectively to both turn a decent profit and provide proper benefits to its consumers, and one that seems to be screwing a segment of its consumers over for the sake of greed.

It's business, run by business people- not doctors, not health enthusiasts and, not priests.

McDonald's cares about the health of its customers so much as in the don't want to blatantly poison them, but beyond that, do they care about the health of they customers?

 

[Ceke2002]

are there any other countries in the world where there are for-profit health insurance companies? I don't think so. Even Saddam Hussein provided free healthcare to all Iraqis.

Australia does have a for profit system of private health insurance, on top of the public health system, but the insurance providers are regulated by an independent body that works to ensure the system remains fair and affordable. If a private health insurer tried to pull the same **** here that Blue Cross has done in Alabama, they wouldn't be in business for very long.

 

[splik]

Australia does have a for profit system of private health insurance, on top of the public health system, but the insurance providers are regulated by an independent body that works to ensure the system remains fair and affordable. If a private health insurer tried to pull the same **** here that Blue Cross has done in Alabama, they wouldn't be in business for very long.

the private insurers in australia are non-profit

 

[Ceke2002]

It's business, run by business people- not doctors, not health enthusiasts and, not priests.

McDonald's cares about the health of its customers so much as in the don't want to blatantly poison them, but beyond that, do they care about the health of they customers?

The Mcdonald's comparison seems rather apt, sadly enough.

 

[Ceke2002]

the private insurers in australia are non-profit

Not all them. Historically that was the case, with most insurers being non profit, mutual societies. Since 2008 though the landscape has changed considerably and is now predominantly for profit.

Private Health Insurance Council of Australia:

http://phiac.gov.au/

 

[Psych56]

This is very upsetting. Instead of just being upset by it however I would like to do something about it. What can physicians do to have more of a voice in these matters?

 

[splik]

Not all them. Historically that was the case, with most insurers being non profit, mutual societies. Since 2008 though the landscape has changed considerably and is now predominantly for profit.

Private Health Insurance Council of Australia:

http://phiac.gov.au/

that's terrible! I knew things were going down hill in australia the past few years, I had no idea it was that bad!

 

[Ceke2002]

that's terrible! I knew things were going down hill in australia the past few years, I had no idea it was that bad!

The Government in power at the moment has managed to p*ss off almost every segment of Australian society, I seriously doubt they'll win the next election. The previous Government did make changes to the Private Health system, but the main purpose was to allow companies to be more competitive and offer more services to try and broaden coverage so that pressure was taken off the Public system. Whether an insurance company is non profit or 'for profit' here, they still have to abide by certain standards. Basically it boils down to one Government getting into power and slashing funding to the Public system left, right and centre, because they keep trying to shift us towards an Americanised version of healthcare, which leaves the other party with the task of implementing policy changes and trying to get the Public system back on track when they get elected.

 

[milesed]

Link to the page
http://apsy.com/

 

[Doctor Bagel]

Wow, this is amazing. Even though the reality of my community is that one of the biggest employers locally has such bad MH coverage that no one in private practice in my community accepts their insurance (unless someone is looking for a training case for analytic training). It sounds similar to life with BC/BS of Alabama now. I doubt this poor MH coverage affects recruiting or retention, though.

Honestly, I think we're moving toward a world where access to truly good care (there's a lot of care on paper that's not really care) will disappear, and people with resources are going to have to pay out of pocket if they really want to get better. Not a great solution for the people who can't pay out of pocket.

 

[Indodo]

I'm not sure what the insurance situation is in Alabama but I doubt that BCBS is the only insurance provider. Certainly in most areas, there is someone who has plurality but it is unusual to see majority of market share. This group was ONLY seeing BCBS patients. They say on their page that BCBS asked them to open offices across the state. These psychiatrists were in effect working for BCBS and BCBS has made layoffs to their employees. It is more subtle but they were de facto employees of BCBS without any of the protections an employee has. They were entirely dependent on BCBS for their paycheck. This was not a margins issue, it was an eggs in one basket issue.

If BCBS truly does have such a large market share in Alabama that they are basically a monopoly, then that is just sad and someone will probably file suit. However, this is just not the case anywhere I am familiar with.

 

[michaelrack]

I'm not sure what the insurance situation is in Alabama but I doubt that BCBS is the only insurance provider. Certainly in most areas, there is someone who has plurality but it is unusual to see majority of market share. This group was ONLY seeing BCBS patients. They say on their page that BCBS asked them to open offices across the state. These psychiatrists were in effect working for BCBS and BCBS has made layoffs to their employees. It is more subtle but they were de facto employees of BCBS without any of the protections an employee has. They were entirely dependent on BCBS for their paycheck. This was not a margins issue, it was an eggs in one basket issue.

If BCBS truly does have such a large market share in Alabama that they are basically a monopoly, then that is just sad and someone will probably file suit. However, this is just not the case anywhere I am familiar with.

I am licensed in MS and Alabama but practice only in MS. About 8 years ago I was looking into opening up a sleep lab in Alabama but was told that BCBS was about 80% of the private insurance market and the rates for sleep studies were much lower than in MS, which has several private insurers. I am not sure what their currennt market share is

 

[jakeislove]

That sucks balls. I have Family in Alabama and was seriously considering moving there.

 

[Indodo]

I am licensed in MS and Alabama but practice only in MS. About 8 years ago I was looking into opening up a sleep lab in Alabama but was told that BCBS was about 80% of the private insurance market and the rates for sleep studies were much lower than in MS, which has several private insurers. I am not sure what their currennt market share is

Did some research about BCBS in alabama. They have 92% of private market share. Also, there are many states with majorities even if it isnt as bad as Alabama. In the top 10 states only 2 have a majority insurer, illinois and North Carolina (5 and 10).
In any case, the alabama situation is terrible and I agree with jakeislove. THAT SUCKS BALLS.

BTW, mississippi has the Mississippi Insurance Group with 84% market share.

 

[jettavr6]

I thought psychiatry is becoming more respected?

Absolutely more respected and now viewed by insurance companies as a threat to their balance sheets. Insurance companies across the board, are trying to narrow down their networks. They will try to negotiate with and include only those physicians who are willing to accept the lowest possible fee. Too early to tell in this case, but I suspect that they will run into some difficulty here.

 

[Ceke2002]

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[michaelrack]

Did some research about BCBS in alabama. They have 92% of private market share. Also, there are many states with majorities even if it isnt as bad as Alabama. In the top 10 states only 2 have a majority insurer, illinois and North Carolina (5 and 10).
In any case, the alabama situation is terrible and I agree with jakeislove. THAT SUCKS BALLS.

BTW, mississippi has the Mississippi Insurance Group with 84% market share.

I have never heard of the Mississippi Insurance Group- is that some collective of private insurers?

 

[Indodo]

I don't know. I just saw a report about insurance coverage. If you have never seen it, its probably a group of insurers.