FloridaPsychologists.NET

Florida Lions : Former BCBS Providers
Lions
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.

Florida LIONS 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.

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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.

 IF YOU HAVE HAD PROBLEMS WITH MENTAL HEALTH ACCESS TO SERVICES UNDER BCBS or Are  Provider ADVERSELY IMPACTED BY

THE BCBS OF FL NEW DIRECTIONS BEHAVIORAL HEALTH TRANSITION take the survey and sign the petition.

 Terms of use - by using this 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
CLICK ON FLORIDAPSYCHOLOGISTS.NET APPLICATION and complete form, then send it back by e-mail or fax.
 (voluntary contributions to support or expand this site may be made by paypal to cpancf@aol.com_

Archive Newer | Older

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. 

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.
10:31 pm edt 

Thursday, October 27, 2011

How not to find the name of a NDBH Psychiatrist; BCBS out of network updates
Our 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.  

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.   

2. 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 place.  
 

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).

2. Their 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 with ND.

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....

10. 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 psychiatrist there.

  IMPRESSIONS:   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


8:58 pm edt 

Dear President Obama / contact your representatives / corporate doublespeak

Dear President Obama,...   Read this letter from Dr. Johnson, a Gainesville psychiatrist...

http://www.sarkisfamilypsychiatry.com/pdfs/LettertoObama10-5.pdf



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 health care.

10:56 am edt 

Wednesday, October 26, 2011

Bill Gallagher Tallahassee Times Piece / BCBS refuses to put grace period in writing

Excellent article, which should be of interest to State of Florida employees enrolled with Blue Cross Blue Shield of Florida:   http://www.psychsearch.net/psych_news/?p=1955

In the meanwhile, employees and providers face continued confusion regarding a possible "grace period" for existing or prior patients of providers who will not be signing with Misdirections, uh..I mean New Directions.   Several providers report there is an internal BCBS memo that will extend all billing and procedures as is for former BCBS providers for 90 days past the Nov 30 deadline.  Some have been told no authorization will be necessary, and that this would apply to all former patients.  Some have been told the billing will go through BCBS as it does now.  But, so far requests from providers to get this in writing so patients and providers wont be wihtout recourse should BCBS decide to not pay, have been met with "Hell no". 

Reports are that BCBS is also now refusing to respond in writing to professional organizations which have submitted queries as to how out of network benefits may work - making it extra difficult for consumers to exercise informed choices about staying with their trusted current providers who may resist "assertive case management" and not follow the "New Direction".

As if that was not enough, BCBS mental health providers, including the office of the publisher of this site, are experiencing long delays in BCBS payments.  We were told that flags in batches of submission for one patient (such as a BCBS request about secondary insurance) can hold up dozens and dozens of claims.  While this is coming to light by providers posting as to what is going on, BCBS holds onto the whole "batch" of money.  In the past, the batches would process and only the flagged pt reimbursement would be held.  I can see where this is good for BCBS of FL, but for providers.....  

3:03 pm edt 

Wednesday, October 19, 2011

NJ Psychological Association sues Magellan and Horizon over privacy violations

With its mental health care carve out and  new policies regarding what apepars to be more strennuous monitoring and management of mental health care treatment will Blue Cross Blue Shield of Florida and New Driections Behavioral Health face similar suits in Florida?

See article here: 
https://www.psychologynj.org/about/newsroom/40-news-and-alerts/71-njpa-privacy-lawsuit-against-horizonmagellan-and-the-state-health-benefits-plan


What is it about BCBS mental health care policies in Massachussets that make psychiatrists insist on in-network PCPs.  Apparently timely acccess to mental health care follow is a problem for MA Blues patients: http://www.annemergmed.com/article/S0196-0644(11)00346-5/fulltext

8:54 pm edt 

Tuesday, October 18, 2011

Dr. D. McKay's BCBS FL New Directions ireport
Dr. McKay, a prominent member and leader of the Florida Psychological Association posted the following CNN i-report. 

In other news: Is the BCBS New Directions controvery attracting the attention of the the Occupy WallStreet movement ?: http://blogs.villagevoice.com/runninscared/2011/09/occupy_wall_str_7.php
1:20 pm edt 

Monday, October 17, 2011

New Directions cutting mentla health provider fees Nationwide.

Nationwide psychologist should become concerned as partnerships between various BCBS and New Directions drastically cut fees.  Colleagues in Kansas, where New Directions is incorporated are facing similar large cuts as those facing psychologists in Florida: http://www.kspsych.org/displaycommon.cfm?an=1&subarticlenbr=62

9:05 pm edt 

Friday, October 14, 2011

Psychologists pay cuts inspire protest - Health News Florda 10:43 pm edt 

Thursday, October 13, 2011

BCBS of FL Putting money in politicians pockets vs caring for mental health 9:23 am edt 

Wednesday, October 12, 2011

American Psychological Association and Florida Psychological Associations critical of BCBS of FL
Click here for a .pdf file of American Psychological Association / Florida Psychological Association letter to US Secretaries of Labor, Health and Human Services and Treasury regarding concerns about mental health parity and Blue Cross Blue Shield / New Directions actions. 
3:47 pm edt 

Tuesday, October 4, 2011

Sarkis Family Psychiatry in Gainesville FL is holding forums and publicizing the fight against drastic changes in the way mental health services will be delivered by Blue Cross Blue Shield of Florida.  Their website even include sample letters and names of legislators to contact.  See: http://www.sarkisfamilypsychiatry.com/resources/insurance-BCBS-new-directions.php
10:08 pm edt 


Archive Newer | Older

Pease visit some of the other sites published by CPANCF.

Click here for a .pdf file of American Psychological Association / Florida Psychological Association
letter to US Secretaries of Labor, Health and Human Services and Treasury regarding concerns about mental health parity and Blue Cross Blue Shield / New Directions
actions. 

Links to the Blue Cross Blue Shield New Directions Controversy

Mental Health New Tricks,
Mental health providers in turmoil as Blue Cross shifts business, cuts rates (Palm Beach Post, September 4, 2011)

Blue Cross providing an illusion of coverage (Dr. Stephen. Ragusea's Letter to the Editor, Key West Citizen, August 25, 2011)


 


Protect your family from the lowest bidder.
Lions
Seek a truly independent psychologist.

Protect your family from the lowest bidder.  Choose a truly independent psychologist.

 

PSYCHOLOGISTS BY COUNTY

 

ALACHUA COUNTY


Clinical Psychology Associates of North Central Florida 
2121 NW 40th Terr. Ste B
Gainesville, FL 32605
(352) 336-2888
Licensed Psychologist since 1989
LION
Websites:  www.cpancf.com

Clinical Psychology Associates of North Central Florida 
2121 NW 40th Terr. Ste B
Gainesville, FL 32605
(352) 336-2888
Websites:  www.cpancf.com
 

Angela Allen-Peck, Psy.D.
Psychology Resident under supervision Dr. Bordini
Clinical Psychology Associates of North Central Florida 
2121 NW 40th Terr. Ste B
Gainesville, FL 32605
(352) 336-2888
Websites:  www.cpancf.com
Jan M. Snyder, Ph.D.
7711 SW 103rd Avenue
Gainesville
Tel Number: 352-495-2709
Website: http://www.drjanmsnyder.com/
Licensed Since: 1983
LION

 

CLAY COUNTY

Dale G. Simpson, Ph.D.
210 SW Nightingale St. Ste B
Keystone Heights, FL  32656
Tel: 352-867-5595
Licensed Since: 1988
LION

 

Dade County
Jerome H. Poliacoff Ph.D.
1501 Venera Avenue Suite #225
Coral Gables, 33146
305.624.7900
Licensed Since:                 1984
LION 

 

 

HILLSBOROUGH COUNTY


Harold R. Linde, Psy.D.
13701 Bruce B. Downs Blvd. Suite 103
Tampa, FL, 33613
(813) 972-4343
Licensed Since 1984
LION
 

MARION COUNTY


Ernest J. Bordini, Ph.D.
Clinical Psychology Associates of North Central Florida 
(352) 336-2888
Licensed Psychologist since 1989
LION
Websites:  www.cpancf.com
www.pediatricneuropsychology.com

David P. Dupere, Psy.D.
3515 SE 17th St, Suite #102
Ocala FL
Tel: 352-867-5595
Licensed Since: 1991
LION

Kathleen J. Kelly, Ph.D.
1701 NE 42nd Avenue, Suite 102
Ocala, Florida
Business Tel Number: (352) 351- 4940
Website:
http://www.driscollkellymruz.com
Licensed Since: 2004
LION 

Benjamin Phalin, Ph.D.
Clinical Psychology Associates of North Central Florida 
(352) 336-2888
Licensed Psychologist since 2011
Websites:  www.cpancf.com

Dale G. Simpson, Ph.D.
3515 SE 17th St #102
Ocala FL
Tel: 352-867-5595
Licensed Since: 1988
LION

 

PALM BEACH COUNTY


Robin Goldstein, Ed.D.
7777 Glades Rd. Ste100
Boca Raton, FL 33434
http://Www.robingoldstein.net
561 212 5408
Licensed in FL since 1984
LION

Gail Greenspoon,Ed.D
2499 glades rd. Suite 203
Boca Raton, fl.
33496
561 392 7779
www.Dr.gailgreenspoon.com
LION
Licensed psychologist since 1992

Lynn Rosen Lampert,Ph.D
2900 Military Trail
South Building
Suite 165
Boca Raton,Fl. 33433
Website:
Licensed since 1985
LION

Barbara Winter PhD PA FAACS
2900 North Military Trail #165
Boca Raton
Tel Number: 561-995-4004
Website: www.drbarbarawinter.com
Licensed Since: 1988
LION
 
 

  SARASOTA COUNTY


Diane A. McKay, Psy.D., P.A.
1990 Main St., Suite 750
Sarasota, FL 34236
Tel: (941) 365-7240
Licensed Since 2000
LION

Volusia County

 
 
 
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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
DISCLAIMER:  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 a provider. 

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