CliniciansUNITED Applauds Senate Action to Limit Insurance “Clawbacks”

Senate unanimously adopts Sen. Rodrigues’ amendment to limit insurance company clawbacks for mental health treatment

BOSTON, MA – Today, private mental health clinicians organized through SEIU Local 509’s CliniciansUNITED campaign lauded the Senate’s unanimous passage of amendment 143, which would limit retroactive claims denials by insurance companies. The passage of Senator Rodrigues’ amendment comes after hundreds of clinicians lobbied and contacted their senators to demand action on this unfair billing practice.

Currently, insurance companies can recoup their payments to a clinician months, or even years, after a therapy session takes place and is paid for, even though therapists secure prior approval from health insurance companies before treating their patients, and then adhere to billing deadlines (usually 60 or 90 days after each session takes place). No similar deadline exists for insurance companies. As a result, companies have demanded that private mental health clinicians pay back thousands of dollars for services rendered years ago in good faith.

The financial burden and uncertainty created by unlimited clawbacks has a chilling effect on therapists and is a limiting factor on their ability to treat patients. More and more clinicians are choosing to leave insurance panels because they find the requirements, the reimbursement rates, and retroactive claims denials too difficult to accept. If there are fewer therapists accepting insurance, people seeking mental health and substance abuse services have a harder time finding qualified therapists to work with at fees they can afford.

“As a clinician with a growing small business, I take pride in our practice’s commitment to accepting insurance for mental health treatment,” said Jen Erbe Leggett, LICSW, who runs a private practice in Roslindale. “Clawbacks and other insurance company practices can make it extraordinarily difficult for providers to accept insurance and families to get the care they need. Today, the Senate took an important step toward ensuring access to quality, affordable mental health care in Massachusetts.”

SEIU Local 509 formed CliniciansUNITED to influence public and private policies that directly impact the vital services clinicians provide in communities statewide, from Medicaid rates to insurance panels. CliniciansUNITED has empowered clinicians in private practice across the state to come together to address the crisis in affordable mental health care. Earlier this year, clinicians testified before the Joint Committee on Financial Services about the need to address insurance clawbacks.

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CliniciansUNITED is a multidisciplinary group of behavioral health clinicians who are associate members of the Massachusetts Human Service Workers Union, SEIU Local 509. Together, we are fighting to ensure each and every Bay State resident has access to quality, affordable mental health services — and to bring about the fair reimbursement policies and practices needed to make universal access possible.

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