Sweetheart Deal Between Insurance Companies and Hospital Systems Concerning Group Therapy Reimbursement
Today I want to draw attention to the sweetheart deal that seems to exist between insurance companies and hospital systems concerning reimbursement for group therapy treatment provided for patients. This fact came to my attention recently when a patient was treated in group therapy for one month at Herrick Hospital in Berkeley, a Sutter Health Affiliate. Blue Shield of California was billed for 20 sessions of group therapy at a rate of $1400.00 per group session for a total of $28,000.00. Blue Shield reimbursed the Sutter Affiliate at that rate.
By contrast, the most Blue Shield has ever reimbursed me as a private marriage and family therapist for one group therapy treatment session with one of my patients on an outpatient basis is $30.00.
Must I have a degree in economics to know that there is something disproportionate in these comparative rates of reimbursement?
This indicates to me that there must exist some extremely preferential agreement between insurance companies and the hospital systems they reimburse. I do hope some enterprising journalist will look into this phenomenon because there is a story here that ought to be told.
And in that story the consumers and independent mental health professionals are the losers.