UnitedHealthcare has recently come under fire for delaying payments to patients, psychiatrists, and therapists by implementing a “pre-payment review” for mental health treatments. This move has caused significant distress among clinicians and patients, particularly in the New York City area, where most reports have emerged.
Key Takeaways
- UnitedHealthcare’s pre-payment review process is delaying reimbursements for mental health treatments.
- Both out-of-network and in-network providers are affected, causing financial strain and administrative burdens.
- Clinicians argue that the process is obstructive and detrimental to patient care.
Surge in Pre-Payment Reviews
UnitedHealthcare, through its subsidiary Optum, has started sending letters to both clinicians and patients requesting detailed medical records for a “pre-payment review” before any reimbursement is made. This has left many patients in a state of limbo, waiting for their claims to be processed. The requested documentation includes entire medical mental health records, which clinicians argue is excessive and time-consuming to compile.
Clinician Concerns
Many mental health professionals have expressed their frustration over the new process. Dawn Baird, a clinical psychologist, described the reviews as “new, predatory, and profoundly obstructionist.” She noted that the amount of data requested goes beyond verifying that sessions occurred, adding that it takes away valuable time from patient care.
Impact on Patients
Patients are also feeling the strain. The uncertainty and delays in reimbursement are causing additional anxiety and depression, making it difficult for them to continue their treatments. One psychiatrist mentioned that the tactic seems to be to delay and deny payments, introducing new elements of uncertainty for patients.
Privacy Concerns
The demand for detailed medical records has also raised privacy concerns. Clinicians are wary of sending sensitive information to insurance companies, especially in light of recent data breaches. This has led to a dilemma where clinicians must balance patient care with the risk of exposing private information.
Broader Implications
The surge in pre-payment reviews is not limited to out-of-network providers; in-network providers are also affected. This has led to delays in payments and increased administrative burdens, making it difficult for clinicians to focus on patient care. The American Academy of Family Physicians has criticized the practice, stating that it creates an inappropriate culture of mistrust and adds no value to the healthcare process.
What Can Be Done?
Barbara Griswold, author of “Navigating the Insurance Maze,” advises clinicians to discuss the release of records with their patients. If patients choose to authorize the release, a written consent form should be signed. However, if patients decide against it, they should be made aware that this could result in their claims not being reimbursed.
The ongoing issue has sparked discussions among professional associations and may lead to further actions to address the delays and administrative burdens caused by UnitedHealthcare’s new review process.
