← Becker’s Healthcare Podcast
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- [00:00]
A
This is Scott Becker with the Becker Healthcare podcast. I'm thrilled today to be joined by Anna Lisa Hansen. And Annalisa spends a ton of time in the pair world. She talks about what she's seeing, what trend she's watching, and a lot more. She's also a long term Chicago White Sox fan, which has been a very hard thing to be the last several years. But she's reliving and wearing her 2005 World Series jersey when the White Sox did win the World Series. And Lisa, tell us a little bit about yourself and what you do today.
- [00:30]
B
Hey. So my name is Annalisa Hansen. I am a licensed clinical counselor in six different states. One of them is Illinois, originally from Minnesota, Chicago. And I got transferred out to Glendale, California back in 2019 when I worked for Cigna Healthcare. So for Cigna, I was one of their network market managers for behavioral health. I was responsible for the entire Western U.S. prior to that I did a number of different jobs for Cigna, including escalated cases, complex cases, complex care cases, utilization management, review management, denial management, you name it. And eventually after the pandemic in California, I decided to make use of my counseling license and I started a private practice. So something that's been very, very interesting for me is seeing from the ground up both how everything works on the payer side, how things work at an insurance company, you know, from the life cycle of a claim contracting network and then regulatory considerations when it comes to insurance, specifically behavioral health care, because that's my focus. But then from the provider side, where are all the ways that, you know, everything falls off the track? You know, like how does, what are all the pain points? How do providers actually interact with the payer system? What is it like being on the other side as a provider? What do all of these different um, rules and regulatory requirements, what are the actual like real world knock on effects that they have for providers? And then industry wide I really keep an eye to what's going on specifically with like big legal cases and then state based regulation, not necessarily national. And I do a lot of outreach and advocacy work on social media and particularly TikTok. I would not say that TikTok is my favorite platform. I very much miss Vine Rip Vine. But the, that is where the eyeballs are right now. Seems much more so than Instagram, much more so than Facebook. TikTok is really where people are highly engaged and for whatever reason people really attached onto my content, which is my underscore goth underscore therapist where I don't really give much in terms of mental health content and tips and whatever I'm all about what is ERISA and what do you need to know and what is 42 CFR and what is this new AI data privacy law in Illinois mean for you if you're a therapist, things like that. So it's really taken off and it's. I think one of the most surprising things is how interested people are in insurance and especially how insurance interacts with mental health.
- [03:12]
A
Fantastic. In what trends are you watching now in sort of the mental health insurance area and how challenging get to get coverage for mental health in the insurance area. What are you seeing there?
- [03:23]
B
It is very difficult. It's really death by a thousand cuts. So all of the major carriers, ever since the change healthcare data outage and I did a lot of videos on the change healthcare data outage because mental health is such a low overhead industry and because the vast majority of mental health providers in America are solo practitioners. So over 72% at last check were solo practitioners. There's very little room for error. And so when the change healthcare data breach happened and Optum United States turned off their claim system and people literally went out of business. They either went out of business, they had to close up shop, they close practices, lay off staff, or they just left the insurance game entirely. And because of the market dynamics of behavioral health, you can very pretty easily run a successful private practice being cash only. And so one of the problems is that we have this huge dichotomy where there are one not enough mental health providers. And I have labor statistics to back that up. And I don't know if we'll have time to get into that. But a lot, a lot, a lot of behavioral health providers just gave up and said, okay, fine, I'm just going to go to a cash based model which locks out, I would say the majority of would be customers in the US who rely on using their insurance benefits. So after the change healthcare data outage a lot most of the big companies needed to start recouping their losses. And so one by one, until all of them have at one point gotten sued, they have been doing what's called prepayment reviews, which is a very sneaky form of kind of pocket denial review where because you are not allowed to deny care by an unlicensed or untrained staff member. Right. So if I'm a therapist and Scott, you are not a therapist, you can't be working for the insurance company and say I think I'm going to deny all of annalise's claims for CPT code 90837 because I just think she sees patients too much and I don't like. You would not be allowed to do that unless you were a licensed social worker counselor like myself, PsyD or MD. Unless you are licensed, you cannot make a determination like that. So what they do is instead of denying the CPT code 90837 which is one hour of face to face therapy, the insurance Companies are instituting PPRs which are called prepayment reviews. And so they will say oh well we saw this, this bunch of claims is 10, 15 claims that you know, we, we have, we suspect might not, might not be correct. And so we are going to require, this isn't a denial but we're going to require you therapist to send in full clinical case notes for all 15 of these claims before we pay them. Which means that, that you know, sets the tolling period. So then they have 30 calendar days. I have 30 calendar days to get that, get those notes to them. If I don't, if I miss the letter in the mail or I miss the missive or I don't, I don't get the notification in time and I miss that 30 calendar days, then they are allowed to deny those claims based on air quotes, non response from provider. So if I do send in all the notes and this has been, I've been going back and forth the flu shield to California on this for gosh, about four months now for one case. They, you send in the notes and then they will look over them and again it's never a licensed person and they will say oh, you didn't use the correct date format or we don't like where you formatted, you know the like we don't like how you formatted this note or you didn't put the, you just wrote out the F code like F41 1 generalized anxiety disorder, but you didn't write out F41 1 hyphen generalized anxiety disorder. Therefore we don't have enough information to complete your claim. And so we're going to send these notes back to you and then we have another 30 days, you know, to ear quotes, gather more information before we approve your claim and so on and so on and so on and so on. This went over gosh at least five times with one of my cases. Now is this completely spurious? Yes. Does this hold up to scrutiny if you actually had it sent to a medical review? No, it would not hold up to scrutiny. Have I sent all of these cases to the Department of Health and Human Services? For California. Oh yeah. But you know, they, they just keep trying it previously. So Cigna had done it for a while. They got in big troubles and then they stopped. And then Anthem tried to do it, I think a year ago. And then they got in really big legal trouble and then they stopped. Then Optum was doing it for a while. They got the smackdown from the apa, the American Psychiatric association and the American Psychological association. So they stopped. So now it's Blue Shield's. So after Blue Shield, I'm guessing, you know, Magellan's gonna gonna feel left out late to the party, right? So then they're gonna start with the PPRs. So this is kind of the thing that I do a lot of education about on my channel where I say, hey guys, look, a ppr. This is not scary, but it is going to delay your claim payment by about 30 to 60, maybe 90 days, depending on how long they want to drag it out, if that makes sense. Scott.
- [08:08]
A
Sure. So a lot of what happens is you have more and more therapists and people in mental health just moving to cash pay where they can, but that just cuts out a huge amount of the, of the potential client base and customer base because a lot of people just can't afford that. Right?
- [08:28]
B
Yeah. But if you think about the fact that, you know, you have all the risk of all of these PPRs, it would be, you know, if you're a business owner, right. And if you're a small business owner, it makes more sense financially if you could run a cash pay practice. I mean, you do it right 100%.
- [08:46]
A
And talk a little bit about what are you, what are you most focused on and excited about as we head towards the end of the year? Annalisa, where are you most. Annalisa, what are you most focused on?
- [08:55]
B
So I am really excited about how many consumers, how many members of, I guess the general public have really taken an interest in insurance recently? Strangely, it hasn't really been providers. Providers have always been very resistant. I think mental health providers have always been very resistant to learning about insurance. I don't know if they think that they despise the system and therefore they shouldn't have to work with it or within it. I do find that very short sighted because if you're going to run a service, run a group, run a clinic that takes people's insurance benefits, you do need to know how to work within the system. So interestingly, the general public is very interested in insurance and they're very interested in insurance law and mandates and little loopholes. Like PPRs, you know, the things that I was talking about. And for whatever reason, talking about insurance on TikTok really seems to resonate with people. For example, this is a big one. There's some videos that are going viral right now about Cigna's new proposed rules that are going to be coming into effect later this month or maybe it's October, about physician down coding. And the, there's a lot of psychiatrists on TikTok that are like, all right guys, here's what we're going to do and here's what down coding is. And these videos are going viral. And you know, people online are just like, down coding. No, like you, you know, they're talking about like, you know, bulk billing and claims. And it's really just fascinating hearing this kind of filter into the public conversation. So I'm really excited to be a part of that and I think it's really interesting as well because you don't really expect, expect that I guess regular Joe on the street would want to hear about state specific, um, mandates. But it turns out they really do because it, it affects them. Right? It affects, it affects their lives. People, you know, rely on insurance to pay for their health care. And so, yeah, the general public is very interested in knowing, like, how do these policies and how do these companies affect you personally? And then the other thing that I'm really excited about is I am looking into some, some parody law arguments for rate increases. More on that later if we talk again. But there's, there's some things would love.
- [11:09]
A
To do that would love to that and always like, where can people follow you on Tick Tock? Where can people find you? Tell us how they can find you and learn more about what you're doing and follow the things you're talking about with insurance and everything else.
- [11:20]
B
Yeah. So primarily on tech talk, I haven't posted for a minute because I've been very, very busy and I apologize. But it's my underscore goth G O T H underscore therapist favorite band is the Cure. And then it is the exact same handle on Instagram. I'm not very active on Instagram. I just mirror and repost all of my TikTok videos onto Instagram, sort of like a backup. And then I am also on LinkedIn but I don't really use that Persona as much on LinkedIn. And then you can always visit our website. It is Gemini, like the star sign counseling and consulting. The counseling obviously is counseling me and then the consulting is. We offer insurance consulting, particularly with behavioral health. Right. So how to navigate your plan, how to read your plan, how to read your eob, how to negotiate a claim denial. And it's really geared towards providers so other therapists, not necessarily patients but this is information for therapists and practice owners. And we also have our own in house counsel which is very unique. He's actually licensed in Illinois. We have a attorney who works with us and he knows a heck of a lot about parity law and about ERISA and he's read the entire Knox Keen act and he can give, you know, kind of casual legal consulting basically on behavioral health as it applies to insurance mandates and policies.
- [12:45]
A
Thank you very very much. What a pleasure visiting with you today. Thank you very, very much for joining us. And Lisa, it's always a pleasure and let's hope the white techs get better. Thank you for joining us.
- [12:55]
B
Hey, I'm in it for the long haul.
- [12:57]
A
God bless you.