Anthem Responds To Criticism Over Psychotherapy Reimbursement

Anthem Blue Cross and Blue Shield in Connecticut responded to criticism by doctors groups that the insurer isn’t paying for psychotherapy when it is provided in conjunction with other medical services.

Wallingford-based Anthem, the state’s largest health insurer, said the American Medical Association published significant changes and updates to the procedure codes associated with behavioral health services, which took effect Jan. 1.

These code changes do not set behavioral health provider reimbursement,” Anthem spokeswoman Sarah Yeager said in a prepared statement. “In compliance with federal law, Anthem implemented the code changes and adopted new fees to match to the new codes. Anthem sought to preserve the level of payment that behavioral health providers were receiving before the code changes.”

Anthem was criticized Thursday by three doctor groups — the Connecticut Psychiatric Society, the American Psychiatric Association and the Connecticut State Medical Society — which claim Anthem responded to the annual change in medical-billing codes by covering only visits for an evaluation or management of medical issues, and not psychotherapy as a separate equal category when provided during the same visit.

The most recent version of “current procedural terminology,” or CPT, medical-billing codes take effect Jan. 1 each year, and psychotherapy has been isolated as a separate service in the past, but with different codes.

“These practices are both unethical and illegal,” the American Psychiatric Association’s chief executive Dr. James H. Scully, Jr., said in a prepared statement. “We worked very hard to enact mental health parity laws, and it is now clear that Anthem is seeking a way to avoid compliance. We are not prepared to allow them to skirt their obligations under the law.”

Anthem’s spokeswoman, Yeager, said, “We believe that our provider reimbursement rates for behavioral health services are appropriate, in compliance with applicable laws, and allow our members to continue to have access to mental health services which we recognize are critical to overall health. All applicable behavioral health services, including psychotherapy services, continue to be covered in accordance with our members’ benefit plans.”