Therapists vs United Healthcare


– Hi, welcome to The Clinician’s Corner, your source for important
news, industry information and tips on starting and
growing your practice. I’m Sean, one of the clinicians on staff here at TherapyNotes. Today, I’d like to talk with you about a class action lawsuit that can potentially
affect your bottom line. For years, we’ve fought for equal pay for the services we provide. In 2008, we took a great step forward with the Mental Health Parity
and Addiction Equity Act. Two years later, provisions
of the Affordable Care Act ensured that behavioral health services were considered essential health benefits and extended protections
of the Parity Act. Despite the significant strides
we’ve taken for better pay, many of us know all too well how low some reimbursement rates can be. Now, someone is fighting back. On October 16th, a class action lawsuit was
filed against UnitedHealthcare and their corporate partner,
United Behavioral Health alleging violations of several laws that resulted in lower pay
for mental health services. Like all other insurers, United offers a contracted
to all in-network providers. For out of network services, United uses an amount referred to as an Eligible Expense. They create this number based
on Medicare reimbursements yet have an interesting exception. For Mental Health and Substance
Use Disorder Services, the Eligible Expense
shall be reduced by 25% for Covered Health Services provided by a psychologist and by 35% for Covered Health Services provided by a master’s-level counselor. How does this work out? The plaintiff’s master’s level counselor billed $120 per 60-minute session and United required 40%
coinsurance from the client. United paid $61.86 on the claim yet 60% of $120 is $72. Where did the remaining $10.14 go? That was the 35% reduction
in the allowed amount due to the fact that the client was seeing a fully licensed, independently practicing
master’s-level clinician instead of an MD. The lawsuit is seeking to
have all claims in the class re-processed and paid based
on the full Eligible Expense with interest. It is also seeking to
have the policy overturned meaning all future claims would be paid without
the adjustment as well. You can read more about the
lawsuit via the link below and subscribe to the
TherapyNotes YouTube channel to stay up to date with
important information on happenings in our field.

3 Replies to “Therapists vs United Healthcare”

  1. United, typically does not allow 90837, only 90834. That reimbursement is $60 and clients want a full 60 minute session. We have reduced the number of clients from United because of this. We are in network, but paid below Medicaid. Cigna is just as bad at a reimbursement rate of $59 for a 90837. They refuse to negotiate the rate, claiming they don't need more therapist.

Leave a Reply

Your email address will not be published. Required fields are marked *