Ensuring fair and timely reimbursement for psychological services is essential to protecting access to care for Connecticut residents and supporting the viability of behavioral health practices.

The Legislative Advocacy Committee of the Connecticut Psychological Association (CPA) is actively working to address insurance reimbursement challenges that impact psychologists and other behavioral health providers across the state. These challenges include:

• Delayed or denied payments for covered services

• Unjustified or vague explanations of benefit denials

• Retrospective claim audits and clawbacks

• Non-transparent reimbursement policies

• Inadequate parity with medical services

These issues not only strain the financial stability of independent and group practices, but they also reduce access to essential mental health care for Connecticut patients.

“Clawbacks” are when an insurance company takes back funds it initially paid to a provider who delivered a service.  Typically, clawbacks occur when the insurance company later determines that the service was not covered.  However, insurance companies reclaim funds years after the service was provided and in large quantities that hurt small businesses.  The full report is listed below and can also be viewed CPA Insurance Clawback Report 2023.

“Access to mental health care is still seriously impeded by a lack of compliance with the 2019 parity bill.  Insurers are still being found in non-compliance. The annual NQTL report put out by the CT Insurance Department in 2023 reported: “in certain instances there was often a failure to provide to the Department’s satisfaction, sufficient documentation demonstrating compliant parity analysis, in the following areas, in the overall pre-authorization and concurrent and retrospective claims denial rate between SUD, MH and Med/Surg benefits, in the rate of concurrent benefit claims between SUD benefits, MH benefits and Med/Surg benefits, and in the out-of-network and in-network claims rate between MH, SUD and Med/Surg benefits.”  Connecticut’s insurance companies were required to provide annual reports to the insurance commissioner requiring their compliance with the new law in 2021. They did not comply with the template the commissioner provide, instead we got a data dump of overwhelming magnitude that was as worthless as it was intended to be.” Testimony by Dr. Mark Spellmann, CPA Legislative Committee