Families in Colorado want help – adults and their children struggle with their mental health but can’t get support when they need it.
“I am so desperate to find foster care for her,” one of the mothers, who asked not to be named, told CBS News Colorado.
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According to the 2021 Colorado Health Access Survey, one in four Colorado residents ages 5 or older say they had eight or more days of poor mental health in the past month; A jump of more than 15% from 2019.
“I don’t have to wait until my child is through a full blown crisis so I can open up care for them based on my insurance,” Nicole Vinson said. She has been trying to take care of her daughter for months.
They’re just two moms willing to share their experience, but the providers we spoke with say their waiting lists are growing every day.
“We currently have over 120 children on our waiting list waiting for services, some of whom have been on that waiting list for nearly a year,” said Blair Skinner, director of Early Childhood Wellness Place in Broomfield.
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She says their attempts to meet the growing need have stalled, largely due to problems with the insurance company, Anthem.
“We tell customers who have Anthem, ‘You’re going to wait two to three times as long as everyone else, unless you choose to forgo your insurance and pay yourself,'” Skinner said.
At Centennial, Kelly Bianucci, operating chair at Children and Family Therapy Center in Denver, deals with the same problem from the same company.
“We’re starting to cap the national anthem queue at 80,” she said.
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Bianucci and Skinner want to add new doctors and help more people, but Anthem says it’s either slow to approve their requests or denied them outright.
“Four Doctors have joined our team since last summer and we haven’t been able to add one to our ‘Anthem’ contract,” said Bianucci.
They say providers are also limited by Anthem in terms of the staff they can hire to see these patients.
“I have three professionals who are candidates for licensure and they’re great and they can see our Medicaid clients, they’re able to see clients who have certain private insurance, but then you have the largest percentage of people on our waiting list right now that Anthem Blue Cross and they won’t allow,” Skinner said. To anyone, unless they have full license to see their clients.”
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I compared these candidates to hospital residents or pre-licensed attorneys.
An Anthem spokesperson said in part: “It is essential to ensure that every provider is licensed and accredited to ensure our members receive effective, high-quality care.” “This process can take some time and we are working to complete the certification of new service providers as quickly as possible.”
“It’s admirable to say, ‘All of our providers are fully licensed and we want only the best for our customers,’ but that really limits the number of providers that are able to see those customers,” Skinner said.
Anthem says it has expanded its network to nearly 10,000 behavioral health professionals, but more than a dozen providers and patients we’ve heard say finding care within the network is nearly impossible.
“She’s literally called dozens of providers, so both major agencies and individual therapists trying to find a provider to see her, someone she can reach out to and be told ‘no new clients’, ‘private payment only’ is a huge waiting list. I just couldn’t find her.” Someone has to treat it,” one mother told us.
Bianucci says Anthem may list a number of providers for its members but with no openings, it says it creates what’s known as a “ghost network.”
“These families are calling, and they can’t find that, so if there are enough providers, how can we connect members to them? We like to send them directly to those options,” she said.
Anthem says it contacts providers monthly, as well as quarterly, and it’s the providers’ responsibility to update if they can accept new patients.
Federal and state parity law requires insurance companies to treat mental health like any other medical conditions, and the Colorado Department of Insurance is tasked with ensuring network adequacy.
Kara Shivers, director of behavioral health programs for the Colorado Department of Insurance, says the latest review found many of the same issues around networking and dependence.
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CBS Colorado correspondent Karen Murphitt asked, “When we talk so broadly about the need for mental and behavioral health, does that prompt you guys to put it at the top of your to-do list?
“If we’re getting complaints, the short answer is ‘yes.’ We know there are some serious problems in this space, which is why we’re currently looking into it.”
Meanwhile, she says, people have more rights than they realize.
“A consumer can go out of the network at an in-network rate after seven days, for example, if there is no provider who can get it within the required seven days. There are provisions outside the network for – mainly for an insufficient network in this case,” she said.
While some insurance companies already do this, we asked if everyone should be required to include pre-licensing candidates in their contracts. She said it’s an issue that many stakeholders will need to consider, but she thinks it’s worth examining.
“I think we, as a country, led by Governor Polis — we’re really thinking about creative ways about how we can expand our provider base. And in terms of pre-licensing work, I think that’s a really interesting and potentially innovative solution.”
State Rep. Matt Soper, who sits on the Colorado Legislature’s Health and Insurance Committee, says that while they’ve tried to address accreditation delays in the past, it’s time to revisit the issue.
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“It really goes back and goes deeper and says, what have we not been able to do last year with the legislation, what do we need to amend?” Because we clearly didn’t get something right.”
But providers say the change should happen soon before the public health emergency, which was put in place during COVID, ends. The policy allowed more people to qualify for Medicaid and many of those families would look for commercial insurance.
“Ending the public health emergency is a ticking bomb for the mental health crisis,” Bianucci said. “You’re going to have up to 20 million Americans, half a million Coloradoans, going from Medicaid to the commercial insurance network. Those commercial insurance networks are already shattered. So an explosion of unmet mental health needs, once that happens is going to be catastrophic.”
With Anthem being one of the largest insurance providers in Colorado, providers worry that it will be the go-to option for many of those families leading to more disruptions to care and even longer waiting times.
“You have to kind of think about the domino effect that you’re creating that’s going down, and then maybe just this piece of paper,” said Vinson, one of the moms.
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Anthem says that since June 2022, 90% of credentials have been completed in less than 30 days. CBS Colorado asked for data to prove this was the case and what the wait times would be for the remaining 10% and we have not received a response.
Providers have also raised concerns about Anthem’s reimbursement rate which they claim is one of, if not the, lowest of all commercial insurance companies. Many of the clinics and professionals we spoke to say they haven’t seen an increase in nearly a decade.
Anthem has not commented on the allegations, saying pricing is confidential. Their full statement reads;
Anthem Blue Cross and Blue Shield believe that behavioral health is critical to a person’s entire health. That’s why we’ve expanded our network of nearly 10,000 behavioral health professionals in Colorado as part of our ongoing efforts to increase access to care. In addition, we are building capacity by offering innovative programs and services, such as virtual access to care.
As we work to improve our network, it is essential to ensure that each provider is licensed and approved to ensure our members receive high quality and effective care. This process can take some time and we are working to complete the accreditation of new service providers as quickly as possible. Since June 2022, 90 percent of credentials have been completed in less than 30 days. If any provider has had a different experience, we encourage them to reach out to us ([email protected]) so we can resolve the matter. We also use an “open network,” which means that we will provide an agreement to any qualified behavioral health provider who requests to join our network.
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The Colorado Department of Insurance is now asking providers to communicate their concerns or file a formal complaint.
You can do this by calling, emailing, or visiting their website.
You can call 303-894-7490 or 800-930-3745, email [email protected] or visit the agency’s website, doi.colorado.gov.