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Dilemmas Behavioral Health Clinicians Will Face in 2023

  • Last Updated : November 3, 2023
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  • 7 Min Read
Dilemmas Behavioral Health Clinicians Will Face in 2023

You’re wrapping up a long day at work, you have multiple notes to finish, and messages to respond to, and you find a letter that an insurance company is reversing payment on all the patients you have seen via Telehealth. A growing number of clinicians, including myself, report having had this experience. Practice-owner clinicians are then faced with multiple dilemmas: Do you continue taking patients with that insurance company? How do you appropriately appeal the claim, knowing that you were just following their estimate of benefits? Do you ask the patient to pay, even though it wasn’t their fault or your own? Clinicians, constantly in a lose-lose situation, struggle to navigate the increasingly complex insurance company requirements. Insurance companies can literally do no wrong – even if they give you the wrong estimate of benefits, they still assert the right to reverse payment at any point.

 

Changing Regulations

 With the previously loosened COVID rules and restrictions winding down, clinicians are finding more and more claims being denied. At the beginning of COVID, there was a collective “thank you” and a sigh of relief that insurance companies were universally covering Telehealth visits. Now, as the rules rollback, clinicians are left again as the middle person between the patient and the insurance company, informing them when the insurance company refuses payment for a Telehealth visit and they now owe the out-of-pocket cost. Here are the top dilemmas faced by clinicians in navigating billing issues:

  • There is no agreement among insurance companies regarding the appropriate place of service and modifier code for Telehealth  visits.
  • Insurance companies are reversing COVID coverage at varying times.
  • Insurance plans within the same company might have different coverage.
  • Insurance companies are not required to uphold the estimate of benefits they provide.
  • Insurance companies often do not specify on their portals what a member’s virtual behavioral health coverage is, requiring a lengthy phone call to the company.
  • Medicare is making frequent changes regarding the requirement of an in-person visit.

 

Digital Health Shifts Without Updates in Laws

COVID certainly increased the ubiquity of virtual platforms used by nearly all business professionals now. This increased awareness of how to use the technology has eliminated the need to spend 5-10 minutes on each appointment setting up the system. But on the contrary, the populous has grown almost “too familiar” with digital health. Taking video calls in cars, airports, beds, break rooms, salons, and restrooms are growing less and less shocking to clinicians. The expectations are also shifting that healthcare providers must offer setups that are of utmost convenience. Patients are growing accustomed to being able to text their therapist, and reach them whenever, wherever. To make matters worse, the laws regarding virtual visits haven’t caught up to the quickly changing technological landscape. Patients frequently travel with the expectation that they can still see their doctor wherever they go, only to find out that the clinician must have a license in the state where the patient is located at the time of the appointment, or risk being convicted of a felony. When the patient now has the ability to text message their therapist while flying, it leaves much room for interpretation in the laws.

 

Decision Fatigue

The increased mental health awareness has been key in reducing stigma and increasing access to care. Start-up companies funded by investors with no interest in quality of care recognize the money-making opportunities in the industry. Start-ups wishing to optimize their return on investment seek to “disrupt” the field with approaches that work well in other industries such as that of the hotel industry. Patients might be confused about expectations when leaving a start-up practice and transferring to a solo practice owner, wondering why other therapists don’t offer the ability to text 24/7. The incredible number of behavioral health directories of mental health providers available online makes it very difficult for even the most motivated patient to work through phone calls to hundreds of providers, asking the three most important questions: “Are you accepting new patients?” “Do you accept my insurance?” and “When is your first availability?” As a result, I frequently experience a tremendous mismatch of unlinked patients and providers. Patients will report to me that they have been trying for weeks to find a mental health clinician and will call lists of providers only to find most don’t pick up the phone or accept new patients. While at the same time, clinicians will often lament in private that they don’t have enough patients. As a consequence, the reported shortage of behavioral health clinicians has been motivating politicians and lobbying bodies to expand the scope of practice for all clinicians, to give all varieties of clinicians the ability to prescribe medications, making it even more difficult for patients to understand their clinician’s training and experience. One could argue that this is not the best approach for patients, and it drives disagreement and outrage among all parties.

 

There are several factors that will contribute to clinician burnout, mainly driven by the increased complexity of dealing with billing issues and charting. After overcoming all the barriers, patients simply want to feel better, and mental health clinicians want to help.

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  • Bruce Bassi

    Dr. Bruce Bassi is a physician, double board-certified in General (adult) and Addiction Psychiatry and is the founder and medical director of TelePsychHealth, which provides virtual mental health treatment across the United States and is based in Jacksonville, FL. He earned a master's degree in biomedical engineering from Columbia University and subsequently graduated from medical school at the University of Michigan. He completed psychiatry residency at the University of Florida, and his addiction psychiatry fellowship at Northwestern University. He enjoys writing and lecturing on the use of technology in medicine to increase clinician efficiency and enhance patient care. His clinical interests are treating addiction and sleep disorders.

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