Testimony on HB 5321: An Act Establishing A State Ombudsman’s Office For Behavioral Healthcare Coverage

Human Services Committee

February 7, 2023

Submitted By Stephen Wanczyk-Karp, LMSW

 On behalf of the National Association of Social Workers, CT Chapter representing over 2,300 members we strongly support HB 5321. This proposed bill is much needed and much overdue.

On a regular basis NASW/CT receives calls and emails from social workers in independent practice who report problems with a health insurer. These complaints run the gamut of missing payments, denied payments without sufficient explanation, retroactive denial of previously approved treatment, problems with credentialing, loss paperwork, inaccurate reimbursement and the list goes on and on. We have even had two members who were not being paid because the insurer had not changed their office address despite repeated notice by the provider (one of them spent 1-year getting this fixed).

The need for this bill is as follows:

1. A NASW/CT survey of members regarding insurance problems that was taken in the summer of 2021 found that 32.5% of respondents had to wait on the phone for over 30 minutes to speak to a representative; 76% had to call back as the issue was not resolved by the first call and 71% reported missing reimbursements. This is all valuable time that the clinician could have spent treating clients, at a time when there is a significant shortage of providers and wait lists for consumers to be seen by a therapist.

2. There exists an uneven playing field where independent providers have no advocate that can effectively address problems with insurers; unlike large health care systems.

3. The degree of problems between independent providers and insurers has reached a crisis stage that is driving clinicians to drop some or all This in turn means that insured individuals who are paying premiums for coverage or have an employer paying premiums (or combination) cannot find clinicians to treat them. This is particularly the case for experienced clinicians and those clinicians with practice specializations such as working with children. Insurer’s provider lists are not updated belying the true limitations of provider panels. One of our members recently stated they “have had to really soul search regarding a commitment to access vs refusing to continue to deal with the unreasonable challenges of insurance companies. Many of my peers happily make twice what I do without the hassle of dealing with insurance companies.” Behavioral health services must not be just for those who can privately pay.

4. Policy makers will be better informed of issues from the data and experience of an independent Ombudsman.

5. The Ombudsman model is a successful approach as demonstrated by the Healthcare Advocate.

6. Legislators will have an effective resource to refer constituents to when contacted by a provider seeking assistance.

NASW/CT urges passage of HB 5321 and encourages Human Service Committee members to co-sponsor this positive, solution-oriented bill.