APA Practice teams with Massachusetts psychology organizations to advocate for neuropsychological services

APA and others allege that BCBSMA is applying policies and procedures in ways that may violate state law and lead to unwarranted denials of care

By Legal and Regulatory Affairs Staff

May 26, 2011—The APA Practice Directorate is collaborating with the Massachusetts Psychological Association (MPA) and Massachusetts Neuropsychological Society (MNS) to confront changes in neuropsychological benefits management by Blue Cross/Blue Shield of Massachusetts (BCBSMA) that impede access to medically necessary care for subscribers.

BCBSMA has restricted its coverage for neuropsychological assessment, while also slashing rates for some neuropsychological services by almost 40 percent. The company changed to requiring detailed written requests for neuropsychological services and then acting on the requests according to criteria purchased from McKesson Corporation. However, the three psychology advocacy organizations allege that BCBSMA is applying policies and procedures in several ways that may violate state law and lead to unwarranted denials of care.

On April 26, 2011, the three groups jointly sent a letter (PDF, 150KB) to the Office of the Attorney General of Massachusetts detailing how consumers are harmed by the company’s systematic denial of medically necessary neuropsychological assessment requests. For example, the letter argues that the review criteria are meant as a benchmark, the starting point for determining what level of assessment is necessary in light of the patient’s specific condition and needs. The organizations assert, however, that BCBSMA uses the criteria inappropriately as inflexible and final limits, regardless of the patient’s unique circumstances as communicated in the authorization request.

The letter asserted that consumers are harmed in many ways by the policies and their implementation, including:

  • Patients who are denied access to proper neuropsychological and psychological testing may be misdiagnosed and therefore treated and medicated for a condition that they do not have, while the underlying cause for their symptoms remains unaddressed. 

  • Patients’ treatment is delayed by the company’s failure to authorize in a timely fashion the assessment needed to determine the course of treatment. 

  • Consumers are not warned that their coverage for medically appropriate services is subject to the hidden and severe limitations of the McKesson criteria, forcing them to pay out of pocket for, or simply forego, assessment services included under their insurance agreement. 

  • Patients have less access to neuropsychological services, and more delays, due to the departure of a number of neuropsychologists who could not afford to remain in the network after the nearly 40 percent cut in reimbursement rates. 

  • By treating diagnosis as the sole goal of neuropsychological assessment, BCBSMA sometimes denies coverage for assessments that are critical to determining why a patient with an established diagnosis is having particular problems or failing to respond to treatment. 

  • When services are denied, patients are faced with a time-consuming appeals process that they are often unable to understand or complete due to their cognitive impairments.

The letter, backed by case examples and other supporting information, followed up on a meeting that representatives of MNS and MPA convened with Massachusetts Assistant Attorney General Thomas O’Brien, chief of the Health Care Division, where the psychology leaders began articulating the concerns.

Michelle L. Imber, PhD, an MNS Board of Directors member who chairs the organization's Professional Affairs Committee and also serves on the MPA Assessment Committee, took an active role in preparing this communication to the Office of the Attorney General of Massachusetts. “As providers and consumers face an escalating barrage of challenges affecting access to care and services,” says Dr. Imber, “it is increasingly important to forge collaborations like this one between local and national organizations. Working closely with the APA Practice Directorate has helped us to place local issues within a larger context. We hope that the work we are doing together we will improve access to needed services here at home and pave the way for similar efforts in other states.”

APA Practice Directorate leaders say they’re eager to collaborate with state psychology organizations on this issue given psychological and neuropsychological testing’s role in professional practice. “These core practice activities are unique to professional psychology,” says APA Executive Director for Professional Practice Katherine C. Nordal, PhD. “It’s important for our advocacy efforts to include protecting the availability and accessibility of psychologists’ testing services.”

According to Alan Nessman, JD, senior special counsel in the APA Practice Directorate’s Office of Legal & Regulatory Affairs, the Directorate has been hearing complaints from members about companies restricting testing and assessment benefits. “In Massachusetts we found what we’ve been looking for – the right assessment scenario for APA to take on as a large collaborative effort with a state association,” says Nessman.

The ongoing interaction with the Attorney General’s Office in Massachusetts isn’t the only initiative in which the two state organizations have teamed up to advocate for psychology.

In a letter to the editors of the New York Times published May 24, 2011, MPA President Dennis P. Girard, EdD, and MNS President Sandra Shaheen, PhD, presented the case for testing to diagnose adult attention deficit hyperactivity disorder (ADHD).