BCBS New Cost-Saving Measures on Mental Health
I'm not sure if this is specific to MA or a new national policy for BCBS HMOs, but I'm curious if anyone is familiar with this. My teenage son went to the ER with serious mental health issues on Friday. Part of what they do at the ER in these situations is to find a mental health facility with availability–they hold you in the ER until there is some option that works based on your condition (and inpatient vs. outpatient). After some effort, they find a facility with availability and discharge him on the assumption that he will begin treatment Monday morning. The provider is out-of-network, but it's the only provider that has availability, and in the past, BCBS approves what they call "single case agreements" in such circumstances where in-network providers are unavailable.
But, it appears that in the last week or so, BCBS has changed policy and will no longer consider single case agreements for psychiatric care–you absolutely must use in-network providers. And if the in-network providers are unavailable, then you can do nothing but wait. I don't think the hospital was aware of the policy change, otherwise, they would not have discharged him.
I gather the business logic for BCBS goes something like this: force policyholders to choose: either wait weeks or months for in-network psychiatric options to become available or decide to private pay for care that is supposed to be covered. And for people who don't have the financial ability to private pay for this care, I'm sure it would also help the BCBS bottom line if some of those kids don't survive waiting for in-network care.
I've talked with multiple providers now who all indicate that BCBS-MA is telling them the same thing–we had an appointment for my son to get care only to be told the night before that BCBS called them and told them of the change in their policy (they had plenty of BCBS patients in the past with no issue).
Does anyone know if this is a national change or just in MA? Is it specific to psychiatric care or a broader change? It seems remarkably callous.
submitted by /u/Burstgreen
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