Open Letter to NASW-NYC Members Regarding HIP's Plan to Decrease Reimbursement Rates
Lynne Spevack, LCSW
Chair, Private Practitioners Group
Dear NASW-NYC Member,
As you may have already heard, HIP (now affiliated with GHI as EmblemHealth) recently announced plans to decrease their rates; for example, LCSW sessions coded as 90806 will be reimbursed at $52, down from $60. I know that many of you are angry about this news. Some of you have inquired about what can be done about this. I will address this issue below, but I first want to say a few words about the trend of diminishing insurance reimbursements. Over the past several years, GHI decreased their LCSW fees from $60 to $55, Medicare fees were reduced, and more recently when Oxford was acquired by United Healthcare there was some indication that Oxford's fees might be lowered. I anticipate that this trend will continue, and that other insurance companies may follow suit. Another, related trend is that client copayments are rising, sometimes as high as $40 or $50 per session. And yes, I have heard of at least one situation in which the copayment ($50) constituted the entire fee.
Returning to the question of what can be done, I want to remind everyone that professional organizations are restricted by antitrust/ monopsony laws from organizing members to oppose fee reductions. (If you are curious, see Wikipedia for a definition of monopsony.) In some cases, individual practitioners who have a special skill that an insurance company identifies as filling a significant gap in their coverage (e.g., a second language) have been able to ( individually) negotiate a higher rate with a managed care company. Sometimes social workers have asked me about whether they, as individuals, should write to protest the company's decision. Of course, each social worker can decide for oneself whether one wants to do this. However, my own opinion is that this is unlikely to accomplish anything. It seems to me that this is a simple matter of supply and demand; in other words, as long as there are sufficient numbers of clinicians (social workers and perhaps other, newly minted licensed mental health professionals) who are willing to accept low rates, the insurance companies will pay low rates. If you feel inspired to take action, it's my opinion that it would be more productive to focus your efforts on working for health care reform, perhaps supporting an organization like the National Coalition of Mental Health Professionals and Consumers (www.thenationalcoalition.org.) In fact, some Private Practitioners Group members are active in advocating for health care reform, and, in my opinion, the prospects are now looking more hopeful.
All that having been said, I recently learned that NASW-NYS contacted the NYS Attorney General's Health Care Bureau regarding HIP's recent actions. NASW continues to advocate on behalf of members regarding problematic practices such as this.
The other thing that I recommend is that you consider the option of moving away from managed care practice, so that you can better insulate your practice from the trend of stagnant and diminishing managed care fees. If you want to learn more about how to do this, you're invited to attend the bimonthly Fee & Marketing Support Group meetings of the Private Practitioners Group at the chapter office (50 Broadway, 10th floor; see http://www.naswnyc.org/ppgmeetings for meeting schedules). You may also be interested in reading the book Breaking Free Of Managed Care by Dana Ackley (published by Guilford Press), as well as my article "12 Tips For Managing Managed Care" which you can read at http://www.naswnyc.org/PPGresources (scroll down); tips # 11 and #9 are particularly relevant to this issue.
My best to everyone,
Lynne Spevack LCSW
Chairperson, Private Practitioners Group, NASW-NYC Chapter
Member, Managed Care Task Force, NASW-NYS Chapter
Psychotherapist, Practice Building Consultant
Financial District, Manhattan, and Midwood, Brooklyn