Blue Cross Blue Shield of Georgia Is Skimping on Mental Health Care, Says Georgia Psychological Association

/PRNewswire / -- Late in 2007, Blue Cross Blue Shield of Georgia (BCBSGa) announced that it was cutting its hourly therapy reimbursement rate for clinical psychologists by approximately 19%. This new rate is about the same as you pay your auto mechanic or home handyman per hour.

However, unlike your mechanic, BCBSGa wants to pay licensed psychologists about half of what they were paid 10 years ago by BCBSGa. In 1998 clinical psychologists were reimbursed by BCBSGa nearly one and a half times today's rate for the same therapy hour. Accounting for inflation, today's rate should be nearly double in 2007 dollars (US Bureau of Labor Statistics based on the Consumer Price Index). Unlike medical doctors and dentists, psychologists see only one patient per hour.

As a result, GPA is hearing from its members that more and more licensed psychologists, especially the most experienced, are finding they can no longer see patients insured with BCBSGa insurance because they cannot run a practice, much less make a living, on what BCBSGa, one of Georgia's largest insurers, is willing to reimburse psychologists

Effective treatment requires highly specialized training and experience. Clinical psychologists licensed in the state of Georgia have either a Ph.D. or a Psy.D. including a bachelor's degree, 4-6 years post-graduate work, plus 1 year supervised internship, and at least one year post-doctoral supervision by a licensed psychologist.

"Research has shown again and again that there is a connection between good physical health and good mental health," said Georgia Psychological Association past-president, Dr. Joni Prince. "And taking a pill alone is not usually the most effective way of improving mental health; psychotropic drugs work better when used in conjunction with psychotherapy," she continued.

But clinical psychologists feel pressured to defend themselves if they see their BCBSGa patients for more than the "licensure type average" of 6.0 sessions, even though BCBSGa offers its PPO customers 50 therapy sessions per calendar year. Major depression, can affect almost 9% of the American population (Mann, New England Journal of Medicine, 10/27/05), and is a leading cause of lost productivity and time off from work. "It seems that Blue Cross is basing treatment decisions on statistics rather than clinical information," Prince said.

What else should you know?

In addition to psychotherapy, psychologists are the only mental health professionals who are qualified to administer, score, and interpret psychological testing instruments, including psycho-educational testing (for IQs, learning disabilities, etc.) and neuropsychological testing, among others.

Yet BCBSGa routinely denies coverage to its customers for psychological evaluations. Evaluations and accompanying clinical interviews are the first step in either diagnosing or ruling out learning disabilities, ADHD, Depression, Anxiety, Bi-polar disorder and other psychopathology. Nearly half (45%) of those with any mental disorder meet criteria for two or more disorders (National Institute of Mental Health press release related to a study published in September 2006 issue of the American Journal of Psychiatry).

Without proper evaluation, mental disorders will go undiagnosed and therefore, untreated. For instance, among adults who have an anxiety disorder about half had symptoms of some type of diagnosable mental illness by age 15, an NIMH-funded study showed. The results emphasize the importance of early diagnosis and treatment of anxiety disorders (NIMH Science Update 2/7/07). "In spite of these studies, many of which are publicized, patients are neglecting their mental health in part due to poor coverage and limited access to quality mental health care," Dr. Prince continued.

Once your child is diagnosed, for example, with Autism or Asperger's, his or her treatment may not be covered by BCBSGa, depending on the type of policy. This flies in the face of Georgia Law, which considers both Autism and Asperger's to be neurological conditions, all of which are mandated by law to be covered equally by insurers (GA Code 33-24-59.10).

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