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Saturday, February 8, 2025

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January jobs report: Unemployment rate falls to 4%, wages rise more than forecast; Trump signs order imposing sanctions on International Criminal Court over investigations of Israel; Ten Commandments in public schools debate reaches South Dakota; Virginia ranks among worst states for wage theft; Mexican long-nosed bat makes appearance in Arizona.

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Attorney General Pam Bondi strikes a Trump tone at the Justice Department, federal workers get more time to consider buyouts, and an unclassified email request from the White House worries CIA vets.

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During Black History Month, a new book shares how a unique partnership built 5,000 schools for Black students, anti-hunger advocates say ag communities would benefit from an expanded SNAP program, and Americans have $90 billion in unpaid medical bills.

Insurance ‘clawbacks’ hurt MD mental health specialists

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Monday, February 3, 2025   

Some mental health care providers said a number of insurance company practices are driving them out of the insurance network, including the little-known practice known as "clawbacks."

A clawback is when an insurance company tells a mental health specialist the care they provided was not actually covered by the patient's insurance, sometimes months or years after the fact, and the insurer wants the money back.

Deborah Steinberg, senior health policy attorney at the Legal Action Center, said it is a tough situation for mental health providers, who are already compensated far less than other medical professionals.

"If you can't rely on that money you've been paid -- that you know was provided related to services that you were supposed to be providing -- it's scary for folks, especially if you're a small or solo practice and you're operating on really thin margins," Steinberg pointed out. "It's an additional burden and a level of anxiety that most people aren't comfortable with."

Steinberg added even if a patient finds a provider in-network, they often run into insurance providers denying claims for behavioral health care. A report by RTI International found insurance companies pay physician assistants 19% more than psychiatrists and 23% more than psychologists.

In 2021, patients had to go out of network three-and-a-half times more often to see a behavioral health clinician than other types of providers.

Jake Swanton, vice president of state affairs for the mental health advocacy group Inseparable, said clawbacks are just part of large administrative costs hindering mental health professionals from providing care. The hurdles, he noted, have led to more providers not taking insurance in order to operate.

"There's just so much pressure on the existing behavioral health providers on cost, and that they're being paid little -- and then squeezed even further by administrative burdens, clawbacks of payments that are being made -- it's forcing a lot of these providers who are just small business owners out of network," Swanton observed. "Forcing them to not take insurance so that they can run their business."

The RTI study also found nearly 7% of Marylanders' visits to behavioral health specialists are out of network, compared to only 0.3% of medical or surgical visits.

Disclosure: Inseparable contributes to our fund for reporting on Criminal Justice, Health Issues, Mental Health, and Social Justice. If you would like to help support news in the public interest, click here.


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