By Joel Warner
By Michael Roberts
By Alan Prendergast
By Michael Roberts
By Michael Roberts
By Amber Taufen
By Patricia Calhoun
By William Breathes
The Lakewood office where Dr. Mary Hansen practices psychology has just two rooms. The tiny, mauve-toned waiting room holds four plain chairs and a table covered with issues of Reader's Digest, Woman's Day and a recent Esquire, with Mr. Rogers on the cover. There's no receptionist asking clients to fill out forms, just a door to the next room, where a Fisher-Price table and chairs await Hansen's smallest clients and whatever therapeutic insights their play might reveal.
Beside a cushy couch, Hansen sits in the therapist's chair, which is positioned for careful listening. But this time she's the one talking.
"Well, I guess I've been really angry," Hansen says matter-of-factly in her soft-spoken voice. "I'm getting past most of it. It's been a while, and it's not something I'm going to devote any more energy to."
Thousands of people who have followed their insurance provider's instructions in seeking counseling over the past few years for relationship problems, addictions, depression, eating disorders, sexual abuse, stress or anger control never realized their therapists might have their own anger issues. For a few hundred psychologists and psychiatrists who saw clients insured by the Mutual of Omaha of Colorado company doing business as Antero Health Plans, though, anger control has been a challenge.
Up until early this year, those therapists were part of a network of mental-health providers managed by a for-profit corporation called, both appropriately and vaguely, Mental Health Services Inc. Owned by three nonprofit community mental-health centers, MHS had contracted with Antero to manage the care of the insurance company's clients who needed mental-health services.
When MHS shut down on February 11, the company still owed $528,467.52 in unpaid claims to 498 therapists and health facilities. The debts ranged from 26 cents owed a therapist in Aurora to a bill of $126,058.87 at University Hospital. MHS stiffed institutions such as Boulder Community Hospital, the Children's Hospital, the Cleo Wallace Center, Parkview Hospital and West Pines for thousands of dollars; even a couple of ambulance companies never collected their fares.
But the majority of those financially traumatized by MHS were individual therapists or therapists who worked in small group practices, trying to run their offices on tight budgets with just a couple of employees. They had contracted with MHS to be on the company's list of mental-health providers in a managed-care environment that often requires therapists to settle for less than the market rate.
"A therapist might usually bill seventy or eighty dollars an hour," says one, "but MHS contracted with us for fifty. We accepted less money, but we would get more referrals." For these providers, a few hundred dollars can mean a lot. Some of them are owed thousands.
"There's no way to know how much I'm owed," says Hansen. "I added up $2,000 worth. They paid $35 [for a client's session], so that $2,000 represents a lot of hours." When she joined the MHS network in January 1996, there were so many problems at first that Hansen thought it was a new business--although by then it had been operating in Colorado for eight years. "There were always questions," Hansen says, "inconsistencies in what they were requesting, so it was hard to bill it, code it." And even after those rough spots were smoothed out, one crucial problem area remained.
"They would take sometimes six to eight months to pay," Hansen says. She looks through the file folders on her lap. "They never paid on that one, so that doesn't count," she says, then says the same thing after looking at the next file. In the remaining files, she finds a claim she submitted in August that was paid in February, a claim from April that was paid in December and one from March that was paid in October.
While the company eventually paid on some claims, MHS was also "finding every excuse in the world" not to pay her at all, Hansen says. "I was to bill them within sixty days of the appointment, and if I was one day late, they wouldn't pay. That didn't have to happen very long before I started billing after every single appointment. I faxed it right on over. Then it would take six or eight months, sometimes calling and calling and calling."
"MHS had always been the worst managed-care provider as far as their rate of reimbursement," says Steve Westra, a psychotherapist who has been in private practice in the area for eighteen years and who contracted with MHS since 1988. "We had a contract with them that said they would reimburse us within sixty days of receiving the claim form, but there are claims they still owe me that are over a year old. Everybody who worked with MHS complained of them being so slow to pay."
Many of the therapists who spoke with Westword about MHS asked that their names not appear because they feared being blackballed from other managed-care companies' provider lists. "Most of those lists are closed. It's very hard to get on the list," says one of these therapists. "When you're on these lists, you can't alienate the people who are going to refer to you. You don't want to be known as a troublemaker."