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."