I’ve included the details, but you can skip down for my question if preferred.
I live in the San Joaquin Valley in California and I recently got an “Anthem Blue Cross Select HMO” plan (according to my insurance card), the first time I’ve ever had insurance that wasn’t Kaiser. I fell off my parent’s Kaiser and I opted to get away from Kaiser because Kaiser’s mental health department is a joke. I have recently wanted to start seeing a therapist and I don’t want to wait 8 weeks between appointments, so here I am with Anthem.
However, I have had a lot of problems trying to schedule an appointment.
When I signed up for my insurance, I had to select a primary care provider (PCP) right then and there. I had to just select someone at random, and I ended up selecting a doctor associated with an IPA/medical group by chance called BFMC. Now, I know that USUALLY, Psychiatry is a specialty covered under medical benefits and Psychology/Behavioral Health is covered separately under mental health benefits. So I called a psychologist that was contracted with Anthem to make an appointment. After a day or two, they called back and let me know I would have to be seen with a provider from BFMC, as any visits at their office would not be covered by my insurance.
I contacted Anthem and they told me they had no idea what the provider was talking about, that I can definitely be seen with any therapist contracted with Anthem, that the IPA/medical group was irrelevant. After a bit of back and forth, it was apparent that BFMC was unique in that they had mental health providers in their network. Two providers, to be precise. I was pretty upset by this, as this is the problem I was trying to avoid, I was looking for a wider network to choose from.
So I promptly called Anthem to change my PCP. I changed to a PCP that is a part of a medical network called DHMN. I called back the same psychologist’s office to make an appointment, assuring them the issue was resolved. They called me back a few days ago to notify me that I had to be seen with a mental health provider at DHMN. I assured the provider again that I had contacted and spoke with multiple people at Anthem who had told me that I would definitely be covered, but they insisted their information told otherwise, insisting that it was because my Anthem is an HMO.
I tried to call DHMN last week but was on hold for 40 minutes without reaching anyone, and I do plan to call again tomorrow. Their provider directory and their website doesn’t list anything about any mental health providers of any kind (not including psychiatry).
MY QUESTION: Are they right? Are there such a thing as medical networks/IPAs that have any bearing on who you can see for mental health care, even though they don’t have a list of those providers available to me? Is there a possibility they are correct or is this provider office incompetence? Why would Anthem be telling me something different?
submitted by /u/musiker4
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I’ve included the details, but you can skip down for my question if preferred. I live in the San Joaquin Valley in California and I recently got an “Anthem Blue Cross Select HMO” plan (according to my insurance card), the first time I’ve ever had insurance that wasn’t Kaiser. I fell off my parent’s Kaiser and I opted to get away from Kaiser because Kaiser’s mental health department is a joke. I have recently wanted to start seeing a therapist and I don’t want to wait 8 weeks between appointments, so here I am with Anthem. However, I have had a lot of problems trying to schedule an appointment. When I signed up for my insurance, I had to select a primary care provider (PCP) right then and there. I had to just select someone at random, and I ended up selecting a doctor associated with an IPA/medical group by chance called BFMC. Now, I know that USUALLY, Psychiatry is a specialty covered under medical benefits and Psychology/Behavioral Health is covered separately under mental health benefits. So I called a psychologist that was contracted with Anthem to make an appointment. After a day or two, they called back and let me know I would have to be seen with a provider from BFMC, as any visits at their office would not be covered by my insurance. I contacted Anthem and they told me they had no idea what the provider was talking about, that I can definitely be seen with any therapist contracted with Anthem, that the IPA/medical group was irrelevant. After a bit of back and forth, it was apparent that BFMC was unique in that they had mental health providers in their network. Two providers, to be precise. I was pretty upset by this, as this is the problem I was trying to avoid, I was looking for a wider network to choose from. So I promptly called Anthem to change my PCP. I changed to a PCP that is a part of a medical network called DHMN. I called back the same psychologist’s office to make an appointment, assuring them the issue was resolved. They called me back a few days ago to notify me that I had to be seen with a mental health provider at DHMN. I assured the provider again that I had contacted and spoke with multiple people at Anthem who had told me that I would definitely be covered, but they insisted their information told otherwise, insisting that it was because my Anthem is an HMO. I tried to call DHMN last week but was on hold for 40 minutes without reaching anyone, and I do plan to call again tomorrow. Their provider directory and their website doesn’t list anything about any mental health providers of any kind (not including psychiatry). MY QUESTION: Are they right? Are there such a thing as medical networks/IPAs that have any bearing on who you can see for mental health care, even though they don’t have a list of those providers available to me? Is there a possibility they are correct or is this provider office incompetence? Why would Anthem be telling me something different?
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