Blue Cross Blue Shield of Florida, the state's largest health insurer, announced plans this month to carve out its mental health insurance policies to a Kansas firm by Dec. 1, and to also cut rates for psychotherapy by 30 percent, alarming mental health professionals statewide.
"Access to mental health services in this state is difficult enough, and this rate cut potentially exacerbates an already overburdened system," the Florida Psychological Association said in an Aug. 10 letter to state Insurance Commissioner Kevin McCarty. "This is one of the largest rate cuts for psychologists that the American Psychological Association Practice Organization has seen nationally in the last 15 years."
An average psychotherapy session of 45 to 55 minutes will be worth $70 come winter, the insurer told providers via a 20-page contract that mandates the doctors' signatures within 15 days.
The current payout for the same session averages $105; each doctor has their own contract with the insurer and the payout depends upon when they joined the network.
Blue Cross' decision will have a grave impact on whether mental health providers can afford to take the insurance, local psychologists say, and an office manager many rely on to process insurance claims.
"I work for seven different doctors, and they're giving them a 30 percent cut," said Peri Dixon of Marathon, who has been processing health insurance claims billing for 15 years. "Some doctors will take it. They're not happy, but they're signing the contract."
Commissioner McCarty's spokesman said Friday that the state office "works directly with companies on specific issues of concern, and generally does not issue press statements about specific company business practices."
But in an Aug. 17 reply letter to the state psychologists, Florida's Deputy Insurance Commissioner Mary Beth Senkewicz said that she talked with Blue Cross officials, who promised to send providers a clarification letter and said they do not intend to enforce the 15-day deadline.
While Blue Cross says it is making the rate changes to better serve its members, one Key West psychologist said it's a grim sign of the times.
"What it's about is purely profits," said Stephen A. Ragusea, a Key West psychologist who only a year ago agreed to join the Blue Cross network at its urging. "It's all about not paying out money. That's how insurance companies make money."
Ragusea, with 35 years of experience, said Blue Cross is making across-the-board cuts of 30 percent to 50 percent for mental health care, "as they try to get people to drop out and leave as few providers as possible."
If the cuts go through as planned, Ragusea said he will leave the preferred provider network to avoid the financial strain.
"It would pay me $24 an hour, after expenses," he said. "I went to college for 10 years as an undergrad and I did my internship and residency, and I've got 35 years of experience. What is that worth?"
Ragusea is one of eight psychologists in the Keys listed as Blue Cross providers on the company's website.
Dixon agrees with the psychologists' organization in that the cuts will eventually force doctors to stop taking the insurance.
"They're going to pay the same premium," Dixon said, of the insured. "But they're not going to have any doctors to go to."
Dixon said that her research determined that of the average rate that different networks offer for mental health care, Blue Cross Blue Shield of Florida (BCBSF) pays the lowest.
"They said they had done their market work," said Dixon, adding that the insurer insists it is well within the average in the field.
Dixon said, "They've gone out of their way to make it harder for providers to collect on legitimate claims."
The insurer, in a statement Friday, said it is striving to lower health care costs for its members, and that New Directions -- a partner firm of BCBSF and a minority shareholder of the Kansas firm -- has specific systems to better ensure that patients receive the best "integrated" care.
"Over the past year, BCBSF has been able to lower its members' medical costs by a considerable amount," said company spokesman Paul Kluding.
To deliver additional medical cost savings for its members, BCBSF said it has entered into several vendor relationships, including its new relationship with New Directions.
The state association believes Blue Cross Blue Shield of Florida's decision over handling what it terms "behavioral health" care may violate a federal law enacted in 2008 that requires "parity" when it comes to companies covering mental health and addiction treatment. The law requires that coverage of physical health equal that of mental health.
"We are concerned about the rights of patients, and the rights of the mental health professionals who serve them," wrote Connie Galietti, attorney and executive director of the state psychological association, in the three-page letter that was copied to the insurer and a congressional representative.