|Florida Lions : Former BCBS Providers
|Declaring their Independence from Mis-managed Care
Welcome to FloridaPsychologists.Net: Who said
there are no Florida Lions?!
Scroll Down on Right Side for Psychologist Directory
FloridaPsychologists.NET is a listing of Florida Psychologists proclaiming their independence from the interference
of managed care or managed care carve outs in mental
health. They are advocates for mental health parity, and do not believe a seperate system of mental health carve outs
or mental health managed care speaks to the spirit or letter of mental health parity laws.
They have taken the harder road of being private practitioners who answer primarily
to their patients and those who consult them for their services.
are former Blue Cross of Blue Shield Providers who made a break with Blue Cross Blue Shield of Florida when effective Dec.
1, 2011, BCBS decided to introduce a mental health carve out, New Directions. A new contract with New Directions was offered.
This included terms many found unacceptable and a reimbursement rate not only below Usual and Customary fees (UCR) and the
discounted rate BCBS PPC and Blue Choice Providers were previously paid, but a rate approximately 30-35% below Medicare rates.
. Many Florida Lions previously only took BCBS insurance, adhering to a higher standard of care and found proposed procedures,
reimbursement, and other policies to be at odds with their abilities to continue to provide the level and quality of care
to the patients and families they serve.
Follow our blog to learn more about the struggle for true mental
health parity and concerns that Blue Cross Blue Shield of Florida and other insurers raise in their treatment of mental health
services and mental health providers.
YOU HAVE HAD PROBLEMS WITH MENTAL HEALTH ACCESS TO SERVICES UNDER BCBS or Are Provider ADVERSELY IMPACTED
THE BCBS OF FL NEW DIRECTIONS
BEHAVIORAL HEALTH TRANSITION take the survey and sign the petition.
site you agree to all disclaimers posted on this site as well as any disclaimers published on the CPANCF.COM site.
FOR A FREE LISTING
FOR FLORIDA PSYCHOLOGISTS WHO DO NOT ACCEPT MANAGED CARE MENTAL HEALTH PLANS
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Thursday, April 5, 2012
PLEASE complete survery on adverse impact Blue Cross Blue Shielf of Florida and New Directions
If you are a patient or provider who has been negatively
impacted by the change in policies or "transition" of mentla health benefits in Florida Blue (BCBS of FL) and New
Directions Policies, the Florida Psychological Association is gathering data for later presentation, possibly in conjuction
with national organizations. To fill out forms go to the FPA homepage: http://www.flapsych.com/
5:36 pm edt
Is BCBS Double Crossing its former providers and patients - Is it time for Class action?
Well new games seem
to be beginning. As you all know there were supposed to be tow grace periods for established patients for
those who did not go with Misdirections. Blue Double cross put in writing the Oct-Dec grace period, but
only promised to multiple providers, often after many calls that this would be extended through March 2012 (remember the fiasco
as to whether o or not patients needed to get authorizations for this. Eventually Misdirections, put out
something in writing, affirming that these would continue to be treated as in-network until March. Up until
now we have been getting conflicting messages with reporting we need to appeal each individually and others claiming, they
realize their screw up and are reprocessing all. We’ll this week, my office manager talked to three
different folks who flatly stated that effective Jan 1 we were no longer providers, so all will be processed as out of network.
This is directly opposite of statements by BCBS and written materials
provided by Misdirections as well as laughable in the context of BCBS representative claims to the medical the transition
will be a smooth one.
5:32 pm edt
Since they seem to be backing out of their oral and written representations, potentially costing
us and patients a lot…is it time to file a formal complaint with the Insurance commission. These
last statements are more than we’re getting to it, they sound pretty defiant to me. IS it time for
a class action lawsuit for damages. Can we get a senior BCBS official to confirm their employees statements
they have no intent to honor their prior representations.
If the statments today by BCBS employees we talked
to are accurate this would seem to represent a new low for Blue Cross Blue Shielf Florida - soon to be renamed Florida Blue
- maybe they shoudl try We give Floridians the Blues!
Monday, November 14, 2011
Humana following suite? Terminating contracts and cutting fees
least one psychologist in Tampa is reporting Humana sent a letter/packet regarding changes that Humana is making and
voiding all contracts after 90 days from 10/31. A new contract with (large)cuts in fees was offered.
10:54 am est
Wednesday, November 9, 2011
New Directions Behavioral Health "Transition" BCBS FL Phone number
12:31 pm est
Seems to be a phone number for asking questions about
the BCBS FL NDBH "transition": 866-287-9569. While some people have reported that
they have been able to get some sort of a list of who to transition patients to, calls this morning indicated that they wont
provide a list until Dec 2, a couple of days after those who do not sign on with NDBH will no longer be under contract.
This seems to beg the quesiton of what this does to continuity of care and what disruption of the care this will cause
for high-risk or fragile patients. I guess its all part of the promised smooth transition and new direction.
if they do say someone is on the ND panel, call the psychologist or psychiatrist's office and make sure. Some members
have complained they were listed on the panel though they have not signed a contract and will not be seeing New Directions
Tuesday, November 8, 2011
Phantom Networks, Disorganization, or Disinformation?
9:10 pm est
New Directions Behavioral Health and its Equity Shareholder
BlueCross BlueShield of Florida seem to continue to cause consternation amongst psychologists trying to refer or transition
patients. Despite BCBS representative's media claims that there will be no disruption and that most providers will sign,
great difficulty has been reported at least by some providers in referring new or existing patients to the MisDirected Provider
network. (See prior blog entry on trying to find psychiatrists in Gainesville).
One provider recently requested
a list of ND in-network providers to refer to, and was provided with a list which included their own name and others who had
not signed and indicated they would not sign with New Directions Behavioral Health. Another provider indicated a total
of only 2 psychologists in the Boca area.
This seems to be alarming news with a few weeks to go. This
would seem to endanger patient care as the lack of reliable information as to who the new providers are impedes continutiy
of care and transfers.
Sunday, November 6, 2011
Fed BCBS Benefits for OON - New Directions transition. For providers
I got a copy of the letter
that went to Federal BCBS patients. My humble read, is that this doess not necessarily show BCBS of FL is changing
what they told us, or any procedures. Feds and out of state plans are all free to make their own policies, so they can
be different, and BCBS of FL did advise us we should check with them. So, for Fed patients there are some
covered under their basic plan and some under standard plan. Under both plans, their benefits will extend under current
allowable to Jan. 29, 2012. However, after Dec 1, 2011 payments will go to them. So, my advice is to collect up
front for federals. Give em a superbill which they can file with a claim which can be found on www.fepblue.org. After Jan 29, 2012 Basic plan Fed BCBS have no out of network mental health benefits.
So they will need to pay up front and cant collect from the feds. Standard plan can file for out of network benefits
which will be paid directly to them (you will be able to collect your full charge at time of service), minus any out-of-network
deductibles or copayments.
8:32 pm est
Not to be considered legal or professional advice. You are on your own!
Tuesday, November 1, 2011
Sample Letter to Blue Cross Blue Shield Patients in Florida
Okay, for you Lions out there, we've made available
a letter updating our understanding of the current Blue Cross mess with New Directions and how we will try to manage it:
Feel free to copy, modify ro distribute - no warranties implied or intended:
5:42 pm edt
Monday, October 31, 2011
New Directions Pressures Providers - Are patients next?
Recent posts to list-serves suggest New Direction/BCBS
of Florida is calling providers informing them that unless they sign with New Directions, patients will be sent disruption
of service letters. Some providers have indicated entire companies have terminated contracts with BCBS. Callers
identifying themselves as from New Directions or Blue Cross are reported to have indicated they will be sending letter to
patients indicating providers are no longer in network and encouraging them to terminate care and transfer to in-network providers
with New Directions.
10:31 pm edt
Providers are concerned that the lettters may not convey what has been told providers
- i.e. there is a 90 day grace period and patients may continue until Feb. 2911 without disrupting continuity of care.
Providers have complained of tactics which seem coercive or "bullying". This all begs the question of what
regard or respect the New Direction brings for providers or potential disruptions of continutity of care.
Thursday, October 27, 2011
How not to find the name of a NDBH Psychiatrist; BCBS out of network updates
office called BCBS to try to obtain further clarification re out of network billing by psychologists and other providers who
are opting not to join New Directions.
8:58 pm edt
1 yes, there is going to be a 90 day
grace period 12/01/11-02/28/12. We are to bill BCBS and will be processed as in network.
There has not been any memo stating this.
Members are to get a letter .
3. Out of network providers are not to bill
New Directions, but bill as they do now to BCBS through Availity.
4. OON providers will still need authorizations, even though they will not be considered
in network. These will be obtained the way they are now.
5. after Dec 1 there is not a limit to sessions. Only the need to have authorization in
6. We were told
BCBS does not have a list of Providers (but a call to member customer service seemed to indicate they have some information
in this regard,we were told there were only two psychiatrists who signed in the Gainesville area)
7. A list of providers would be mailed to members or available online.
8 as to the question regarding the lack of a contract with
the OON provider. This did not seem to be a concern of theirs.
9. It seems none of this pertains to new patients, only existing patients.
Another provider spoke to"Kia" at BCBSFL and was
told the following:
1. Rates for out-of-network (starting December 1, 2011) will be the same as those paid to BCBSFL
in-network providers currently, but only for Decemebr thru Feb. 2012.
2. Out-of-netwrok allowable rates after
the end of Feb 2012 will be at the "usual and customary" amount, based on a statewide assesment, but "Kia"
could not reveal this detail as that was considered private.
3. Use of Availity will continue for both in-network
and out-of-network providers.
4. through Availity you can calculate the inidvidual patient allowables
and co-pays for specific CPT codes per provider. Through the end of November 2011 the calculations will indicate the professional's
current status with BCBSFL (In or Out-of-Netwoork)
5. When you use Availity for determination of benefits, the
information will include whether that particular patient's policy requires Pre-Authorization for a CPT code and whether you
will need to send in an OTR for an out-of-network service, regardless of who files the claim - provider or patient
Now for how it works as of today: What
its like trying to get the Name of a New Directions Behavioral Health contracted psychiatrist to coordinate care:
1. Went onto New Directions website. Patient was in session with me, so I had her BCBS and info handy.
They have a nifty looking search provider function. You enter the member number and zip…And you get…..
ZIP. Number not valid (though in fact I have approved sessions with her very valid member number).
nifty site has a 1-800 number. Called it; Sorry, this is EAP services...but the nice person decided to help me anyway. Could
not verify the patient member number or tell me who if any psychiatrist was in Gainesville FL. Suggested I call the customer service number on the back of pts card (BCBS).
3. All our representatives are busy
4. Please hold
5. Got through to a human
who seemed a bit bewildered why I was asking about New Directions psychiatrists (it does not go into
effect until Dec 1).
6. Explained the general concept
of continuity of care for a patient.
7. She searched
whatever database she had.... Seems she could find few M.D.s or Ph.D.s (though I had not asked about the later) that had signed
8. Gave me three names, and even phone numbers.
Oh, one of the names is a Ph.D., she thinks he must be a psychologist.
9. Tried to find the other two names as psychiatrists in the yellow pages, Shands directory, google..... I
didn't recognize them as local psychiatrists....
Gave up on that
11. Figured Shands must be one of those groups who gets
exempt from Misdirections - Called Shands outpatient psychiatry an efficiently set up an appointment with a
Phone numbers on the fancy New Directions website don't seem to go to right department. New Directions at this point still
cannot tell patients who is on the new directions panel. Blue cross seems to get confused as to who is a psychiatrist and
who is a psychologist. We have a grand total two names of psychiatrists as of this date who will see New Directions
people in the future Gainesville network. They are not listed in the phone book, internet or anywhere
Dear President Obama / contact your representatives / corporate doublespeak
10:56 am edt
Dear President Obama,... Read this letter from
Dr. Johnson, a Gainesville psychiatrist...
From the Sarkis Family Psychiatry
site: View a sample letter for writing to your legislators >
Finally, BCBS FL Corporate Double Speak: BCBS FL officials have done a number of puff PR pieces
and "editorial replies" assuring the transition for mental health patients from traditional BCBS plans to New Directions
woudl be seemless, not cause problems in service and implied if not stated more than a month ago that the majority of patients
wouls still be able to see their current providers and plenty of providers were signing up. However, calls and list-serve
posts indicate providers and patients are having a hard time locating the mystery New Directions providers. Providers
who have not signed are being told that now, in late October (a month after the news PR stories they were doing fine), the
New Directions panel is "60% full". Well, what is it BCBS / ND? Are you or are you not seeing a great deal
of reluctance to go to..., a New Direction?.
Where is the FL insurance commission on this? Consumers and providers
have no written assurance of a further grace period fpr current contracts while they sort this mess out. BCBS decision
not to put it in writing is not consumer and provider friendly. We urge the insurance commission to step in and have
BCBS put in writing, what they seem to be telling consumers. Maybe is not acceptable with respect to valuable mental
Pease visit some of the other sites published by CPANCF.
to US Secretaries of Labor, Health and Human Services and Treasury regarding concerns about mental health parity and
Blue Cross Blue Shield / New Directions
Links to the Blue Cross Blue Shield New Directions Controversy
Mental Health New Tricks,
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PALM BEACH COUNTY
Robin Goldstein, Ed.D.
7777 Glades Rd. Ste100
Boca Raton, FL 33434
561 212 5408
Licensed in FL since 1984
Licensed psychologist since 1992
2900 Military Trail
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FAACS2900 North Military
Tel Number: 561-995-4004
Licensed Since: 1988
Diane A. McKay,
Main St., Suite 750Sarasota,
FL 34236Tel: (941)
This site is a private site, with no official affiliation with the Florida Psychological Association
(FPA). Free Psychologist Listings however, are limited to FPA members or by special exception.
We hope that you agree that your mental health diagnosis and
treatment is too critical to have a third party interfere with or rush.
Careful and thorough assessment helps reduce overdiagnosis of conditions
which may have life-long implications, while underdiagnosis and misdiagnosis can lead to negative life consequences due to
lack of proper treatment. This is too important to go to the lowest bidder.
With so much at stake, trust truly independent psychologists who is
not being coached or restricted by a third party with respect to the assessmet and
treatment of you or your precious family.
Published by Clinical Psychology Associates of North Central Florida * 2121 NW 40th Terrace
Suite B * Gainesville * FL * 32605 http://www.cpancf.com
The owner and publishers of this site make no warranties or representation about any of the providers listed on this site.
The site is simply to provide an advertising list of providers who have broken with managed mental health care. You should check
with other resource to cerify licensure status, past discipline, your local physicians and other psychologists before selecting