Colorado Mental Health Providers Say Slow Credentialing By Anthem Insurance Leading To Massive Waitlists For Care

Colorado families need help. adults and their children have mental health problems but cannot get support when they need it.

"I'm so desperate to find treatment for him," the mother, who asked not to be named, told CBS News Colorado.

According to the 2021 Colorado Health Care Access Survey, one in four Coloradans ages 5 and older report experiencing eight or more days of poor mental health in the past month; A jump of more than 15% compared to 2019.

"I don't have to wait until my child is in crisis to take out insurance on my insurance," said Nicole Vinson. She has been trying to take care of her daughter for several months.

There are only two mothers willing to share their experiences, but the providers we spoke to say their waiting lists are getting longer every day.

"We currently have over 120 children on the waiting list for services, some of whom have been on the waiting list for almost a year," said Blair Skinner, director of early childhood health at Broomfield.

He says their efforts to meet the growing demand have stalled, largely due to issues with Anthem Insurance.

"We tell customers who have Anthem, 'You're going to wait two or three times as long as others unless you decide to drop the insurance and pay for yourself,'" Skinner said.

Kelly Bianucci, president of the Denver Center for Child and Family Therapy at Centennial, struggles with the same problem at the same company.

"We started filling our waiting list for the national anthem at 80," he said.

Bianucci and Skinner want to add more doctors and help more people, but Anthem, they say, has been slow to approve or deny their requests outright.

"Since last summer, we've had four doctors on our team and haven't been able to add anyone to our Anthem contract," Bianucci said.

Providers, they say, are also limited by Anthem in the staff they can use to see these patients.

"I have three great license applicants and they can see our Medicaid clients, they can see clients who have private insurance, but Anthem Blue Cross has the largest percentage of our waiting list right now and they're not letting anybody in." …they will not see until they are allowed to meet with their clients,” Skinner said.

He compared these candidates to hospital residents or pre-licensed attorneys.

"Ensuring that each provider is licensed and accredited is important to ensuring that our members receive high-quality, effective care," an Anthem spokesperson said in part. "This process may take some time and we are working to complete the accreditation of new providers as quickly as possible."

"It's nice to say that 'all of our providers are fully licensed and we only want the best for our customers,' but that really limits the number of providers that those customers can see," Skinner said.

Anthem says it has expanded its network to include nearly 10,000 mental health professionals, but the more than a dozen providers and patients we've heard about are nearly impossible to find online.

"I have called literally dozens of health care professionals, both large agencies and individual therapists, to find a provider to contact and they have told me, 'No new clients,' 'Private pay only,' 'I have a large list of expectations. I couldn't find anyone to take care of him," one of the mothers told us.

Bianucci says Anthem can list multiple providers for its members, but without opening up, it creates a so-called "ghost network," he says.

“These families are calling but can't find them, so if there really are enough providers, how do we get members to contact them? We would like to direct them directly to these options,” he said.

Anthem says it contacts providers on a monthly and quarterly basis, and providers must report whether they can accept new patients.

Federal and state fairness laws require insurance companies to treat mental health the same as any other medical condition, and the Colorado Department of Insurance is responsible for ensuring network compliance.

Kara Chivers, director of mental health programs for the Colorado Department of Insurance, said their latest audit revealed many of the same problems with networks and accreditations.

"If we talk extensively about the need for mental and behavioral health, does that make you want to put it at the top of your to-do list?" asked CBS Colorado reporter Karen Morfitt.

"If we get complaints, the short answer is yes." We know there are serious problems in this area, so we are looking at it now,” Cheever said.

At the same time, he says people have more rights than they think.

"For example, the consumer can disconnect from the network after seven days at the network rate if there is no provider that can receive it within the required 7 days. insufficient network,” he said.

While some insurance companies already do this, we asked whether all should be required to include pre-authorization applicants in their contracts. He said it was a multi-stakeholder issue but thought it was worth discussing.

“I think as a state, led by Governor Polis, we're really thinking about creative ways to expand our supplier base. As for the pre-licensed work, I think it's really interesting and promising. creative solution," he said.

Rep. Matt Soper, who serves on the Colorado Legislature's Health and Insurance Committee, said that while there have been efforts in the past to address credit delays, it's time to revisit the issue.

“It's really a return, to go deeper and say what we couldn't do with legislation last year, what do we need to fix? because of course we misunderstood something," he said.

But vendors say the change is expected to come just before the end of the public health emergency imposed during COVID. This policy has enabled more people to qualify for Medicaid and many of these families will seek commercial coverage.

"The end of the public health emergency is a ticking time bomb for the mental health crisis," Bianucci said. "You'll have up to 20 million Americans and half a million Coloradans coming off Medicaid and getting commercial insurance. These commercial insurance networks are already expanding. Hence the explosion of unmet mental health needs when that happens. It will be a disaster."

Because Anthem is one of Colorado's largest insurance providers, providers fear it could become an alternative for many of these families, leading to more interruptions in care and more waiting.

"You kind of have to think about what kind of domino effects you're creating that goes beyond maybe just a piece of paper," said Vinson, one of the moms.

Anthem reports that as of June 2022, 90% of accreditations are completed in less than 30 days. CBS Colorado requested data to support this and a holding time for the remaining 10%, but we have not heard back.

Sellers also raised concerns about Anthem's reimbursement rate, which they say is one of, if not the lowest, of any commercial insurance company. Most of the clinics and professionals we spoke to say they haven't seen an increase in nearly a decade.

Anthem did not comment on the claims, saying the prices were confidential. Their full statement reads:

Anthem Blue Cross and Blue Shield believes that behavioral health is essential to a person's overall health. That's why we've worked to expand our network of nearly 10,000 behavioral health professionals in Colorado as part of our ongoing efforts to expand access to care. We are also building capacity by introducing innovative programs and services such as virtual access to care.

As we work to expand our network, it is important to ensure that each provider is licensed and accredited to ensure that our members receive effective, high-quality care. This process can take time and we aim to complete the accreditation of new suppliers as quickly as possible. Since June 2022, 90% of accreditations have been completed in less than 30 days. If providers have a different experience, please contact us (COProviderRelations@carelon.com) so we can resolve the issue. We also operate an 'open network' which means we will agree to any qualified behavioral health care provider who asks to join our network.

The Colorado Department of Insurance is now asking providers to resolve their issues or file a formal claim.

You can do this by calling, emailing or visiting their website.

You can call 303-894-7490 or 800-930-3745, email DORA_Insurance@state.co.us, or visit the agency's website at doi.colorado.gov.

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