New Law on Mental Health Insurance Lacks Enforcement

A law the N.H. Legislature passed in May could help patients on private insurance plans more quickly connect with a mental health professional. But whether the law will be enforced as written remains to be seen.

House Bill 507, which takes effect in January, gives private health insurers 30 days to process credentialing applications, which mental health providers submit to join an insurer’s network. The bill, signed by Gov. Kelly Ayotte, aims to increase the speed at which mental health professionals can begin providing care to patients with private insurance.

Currently, insurers operating managed care plans have 45 days to credential practitioners and add them to their network. Despite the law, this process can often take months, according to Jayson Pratt, the CEO of Anew Behavioral Health, which has locations in New Hampshire and Ohio. This creates uncertainty for providers and delays the ability of recently hired practitioners to start providing care, Pratt said.

Anew has a waitlist of more than 50 patients, and is in need of more mental health practitioners. When Anew’s location in Keene or elsewhere hires a new mental health provider, they must go through a credentialing process for each insurance company before they are accepted into the insurer’s network. Although licensed providers can still practice, many of their patients must wait until the provider is accepted, Pratt explained. During the process, Pratt said, delays, resubmissions and other forms of red tape create an administrative barrier between the providers and their patients.

While patients have the option of paying out of pocket for their care, many cannot afford to, according to Gina Pasquale, executive director of Maps Counseling Services in Keene. Roughly 60 percent of Maps’ clients use private insurance, she said.

“The faster this process goes, the faster [providers] are up and running and seeing people,” Pasquale said. “On a collective, community level, it’ll help us get people off of the waitlist.”

But although the law will create a tighter deadline, it doesn’t guarantee insurers will follow it.

D.J. Bettencourt, commissioner for the N.H. Insurance Department, said via email the original text of the bill contained a provision that would have required insurers to reimburse care from the day the credentialing application was submitted. However, this provision was removed from the bill’s final version.

The lack of stricter enforcement creates issues for mental health providers, according to Dr. Mindy Asbury, chief medical officer of Monadnock Family Services. The Keene provider has roughly 350 patients on private insurance plans, comprising 18 percent of its patients. Some insurance companies can take up to three months to process credentials for clinical staff, Asbury said.

“Absent significant investment in credentialing workforce and process improvement to increase the efficiency of the credentialing process, it is unclear how the 30-day deadline will be met, especially given that the current system does not meet the 45 days timeline,” Asbury said via email.

The delays in the credentialing process increase administrative work and overall costs for providers, while also delaying needed care for clients, Asbury said. “Some of the insurances are extremely difficult to deal with.”

Anthem Blue Cross/Blue Shield, the largest health insurer in New Hampshire, as well as UnitedHealth and the N.H. Association of Insurance Agents did not respond to requests for comment.

The new law comes as New Hampshire faces a shortage of mental health providers, and a population with greater need for mental health care. In February, N.H. Public Radio reported that widespread frustration exists among New Hampshire therapists who are facing administrative barriers and delayed payments from private insurers, and this puts patients and practices at risk.

“On one hand you have clients who are desperate for care, and you have providers who want to work,” Pratt said. “People can’t wait for three months for care. We are in constant need of new providers to address that backlog.”

This creates a challenge when a practice is trying to hire new providers, Pasquale said.

“It does make it hard when you’re onboarding folks, when they’re ready, they’re available, they want to see clients, but they are hampered by the red tape,” Pasquale said. “We want it to go as quickly as possible, and we want our applications to be as clean and complete as possible.”

And for clients on waitlists, timing is everything, Pasquale noted. “The longer care is delayed, ... the worse the problem becomes, and the harder to treat the problem becomes. Early intervention is always best.”

Bettencourt, the insurance department commissioner, touted the new law, saying via email it will recognize outpatient mental health providers as a vital part of health care.

“For them, time is money,” Bettencourt said. “Delays in credentialing mean lost revenue and, more critically, delayed care for patients or out-of-network bills they shouldn’t have to pay.”

Bettencourt characterized the law as “pro-provider, pro-patient, and pro-market,” and a “a model of common-sense reform.”

But Pratt, of Anew Behavioral Health, believes larger changes need to be made, especially since providers who are being stalled during the credentialing process are already licensed.

“We can’t just have them sitting around,” Pratt said, pointing to the disorganized nature of different insurance networks. “We need a national system. ... In the meantime, all that does is take insurance companies off the hook for payments.”