|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
(voluntary contributions to support or expand this site may be
made by paypal to firstname.lastname@example.org_
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
Wednesday, October 26, 2011
Bill Gallagher Tallahassee Times Piece / BCBS refuses to put grace period in writing
3:03 pm edt
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
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.....
Wednesday, October 19, 2011
NJ Psychological Association sues Magellan and Horizon over privacy violations
8:54 pm edt
Tuesday, October 18, 2011
Dr. D. McKay's BCBS FL New Directions ireport
1:20 pm edt
Monday, October 17, 2011
New Directions cutting mentla health provider fees Nationwide.
9:05 pm edt
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
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
Some interesting articles:
Wednesday, October 12, 2011
American Psychological Association and Florida Psychological Associations critical of BCBS of FL
3:47 pm edt 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.
Tuesday, October 4, 2011
10:08 pm edt
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
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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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Tel Number: 561-995-4004
Licensed Since: 1988
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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