Anthem Agrees To Reprocess 28,000 Claims Related To Psychotherapy, Pay $400,000 To Medical Providers

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Anthem Blue Cross and Blue Shield in Connecticut agreed to pay $400,000 to psychiatrists and behavioral-health providers for services dating back to Jan. 1 and to reprocess thousands of claims, the state Insurance Department said Wednesday.

At issue is the way Anthem interpreted new medical billing codes issued by the American Medical Association that took effect on Jan. 1.

Anthem was criticized last month by three doctor groups — the Connecticut Psychiatric Society, the American Psychiatric Association and the Connecticut State Medical Society — which claimed 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.

As a result, medical providers of psychotherapy either were not paid for the service, or the customer was faced with covering the extra cost for psychotherapy, the doctor groups said. Anthem said last month the company was covering applicable behavioral health services, including psychotherapy, in accordance with its members’ benefit plans.

“Through the department’s regulatory oversight of Anthem claims payment practices it was determined that Anthem had to revisit the way it was applying a new set of medical billing codes for reimbursement of claims and make the proper adjustments,” Connecticut Insurance Commissioner Thomas B. Leonardi, head of the Insurance Department, said in a prepared statement. “As a result, the carrier has now provided the department with a remediation plan that will make the fair and correct adjustment for providers for all affected services on or after January 1.”

Anthem is reprocessing about 28,000 medical claims since the start of the year.

Anthem spokeswoman Sarah Yeager said “ … first and foremost assure our members and participating providers that Anthem continues to cover all behavioral health services, including psychotherapy, in accordance with our members’ health benefit plans.”

“Earlier this year, we adopted a new behavioral health fee schedule for psychiatrists and APRNs [advanced practice registered nurses] as a result of the American Medical Association issuing a new set of billing codes for them,” Yeager said in a prepared statement. “In close cooperation with our regulator, the Connecticut Department of Insurance, as well as with input from the Office of the Attorney General, we are making certain adjustments to that fee schedule.”

About Matthew Sturdevant

Full-time staff journalist at The Hartford Courant and magazine freelancer with a master's degree in writing from Dartmouth. My work has appeared in The Los Angeles Times, The Chicago Tribune, Taiwan News, The Baltimore Sun and many other news sources. My blog has been referenced by Politico.com, the Kaiser Family Foundation, the Georgetown Law Library and a number of organizations in healthcare and business. Sturdevant’s blog is "a well-written wealth of ideas," said The Donald W. Reynolds National Center for Business Journalism, (businessjournalism.org, May 18, 2011). I have experience writing for newspapers, magazines, Web sites and blogs as well as shooting and editing video. I made regular appearances on news-talk radio and on the NBC affiliate station in Corpus Christi, Texas. I made occasional appearances on the Fox affiliate in Connecticut promoting Hartford Courant articles.

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3 thoughts on “Anthem Agrees To Reprocess 28,000 Claims Related To Psychotherapy, Pay $400,000 To Medical Providers

  1. Andrea Day

    It is just right that Anthem should do what they are expected to do. After all their clients have paid them exactly as what has been their amortization rate is. This is such a good news to their client as well.

    StevenCope.com

    1. jfaRR

      thank you.you are truly blessed.these people get it right and i will go back and delete.and appoligize.and leave some good comments .but right now im hurting,kids are starving,the dog that attacked me is still getting out.and im 3 days from being homeless,and im was already disabled before the dog attacked me.and they cant even se
      nd me 20.00bucks?what kinda customer service is that?

      1. jfaRR

        im just saying u got bigger issues out here like the hartford ins.group discriminating against me a low income roswell n.m. resident.what up?

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