Colorado mental health providers say slow credentialing by Anthem insurance leading to massive waitlists for care

Families in Colorado want help -- adults and their children are struggling with mental health but can't get support when they need it.

"I am so desperate to find care for her," one mother, who asked to be anonymous, told CBS News Colorado.

According to the 2021 Colorado Health access survey nearly one in four Coloradans ages 5 and older say they had eight or more days of poor mental health in the past month; a more than 15% jump from 2019.

"I shouldn't have to wait until my kid is in complete crisis mode to be able to unlock care for them based on my insurance," Nicole Vinson said. She's been trying to get her daughter into care for months.

They are just two of the mothers willing to share their experience, but providers we spoke with say their waitlists are growing every day.

"We currently have over 120 kids on our waitlist waiting for services, some of whom have been on that waitlist close to a year," Blair Skinner, director of Early Childhood Wellness Place in Broomfield said.

She says their attempts to meet the growing need have stalled, largely due to issues with the Anthem Insurance company.

"We tell clients who have Anthem, 'you are going to be waiting two to three times as long as everyone else, unless you choose to forgo your insurance and come in self pay,'" Skinner said.

In Centennial, Kelly Bianucci, the operating chair for the Child and Family Therapy Center of Denver, is dealing with the same issue from the same company.

"We started capping our Anthem waitlist at 80," she said.

Bianucci and Skinner want to add new clinicians and help more people but Anthem they say is either slow to approve or denying their requests altogether.

"We have had four clinicians join our team since last summer and have not been able to get a single one added to our Anthem contract," Bianucci said.

Providers they say are also limited by Anthem on what staff they can use to see those patients.

"I have the three licensure candidate professionals who are fantastic and they are able to see our Medicaid clients, they are able to see clients who have certain private insurance, but then the largest percentage of people on our waitlist right now have Anthem Blue Cross and they will not allow anybody, unless they are fully licensed to see their clients," Skinner said.

She compared those candidates to residents in a hospital or pre-licensed attorneys.

"It is essential to confirm each provider is licensed and credentialed to ensure our members receive high quality, effective care," a spokesperson for Anthem said, in part. "This process can take time and we are working to complete credentialing of new providers as quickly as possible."

"It's very admirable to say, 'all of our providers are fully licensed and we only want the best for our clients,' but that really limits the number of providers that are able to see those clients," Skinner said.

Anthem says it's expanded its network to include nearly 10,000 behavioral health professionals but more than a dozen providers and patients we've heard from say finding in-network care is nearly impossible.

"I have literally called dozens of providers, so both larger agencies and individual therapists trying to find a provider to see her, somebody she can connect with and have been told 'not accepting new clients,' 'private pay only,' 'have a significant wait list.' I have not been able to find someone to treat her," one mother told us.

Bianucci says Anthem may list a number of providers for their members but without openings, she says it creates what's known as a "ghost network."

"These families are calling, they are not able to find that, so if there's truly enough providers out there, how can we put members in touch with them? We would love to send them directly to those options," she said.

Anthem says it contacts providers monthly, as well as quarterly, and it's the providers' responsibility to update whether they can accept new patients.

Federal and state parity law requires insurance companies treat mental health like any other medical conditions and the Colorado Department of Insurance is tasked with ensuring network adequacy.

Cara Cheevers, director of behavioral health programs at the Colorado Division of Insurance, says their latest review found many of the same issues around networks and credentialing.

"When we are talking widely about the need for mental and behavioral health, does that prompt you guys to want to put it on the top of the to-do list? CBS Colorado Reporter Karen Morfitt asked.

"If we are receiving complaints, short answer is 'yes.' We know there are some serious problems in this space, which is why we are currently looking into them," Cheever's said.

In the meantime, she says people have more rights than they realize.

"A consumer is able to go out of network at an in-network rate after seven days, for example, if there's no provider that can get them within the required 7 days. There are out-of-network allowances for -- basically for an inadequate network in this case," she said.

While some insurance companies already do, we asked if all should be required to include pre-licensure candidates in their contracts. She said it's an issue that several stakeholders would need to weigh in on, but thought it was worth considering.

"I think we, as a state, spearheaded by Governor Polis -- we are really thinking of creative ways on how we can expand the provider base. And in terms of the pre-licensure work, I think that is one really interesting and potentially creative solution," she said.

State Rep. Matt Soper, who sits on the Health and Insurance Committee in the Colorado State Legislature, says that while they have tried to address credentialing delays in the past, it's time to revisit the problem.

"It's really going back and taking a deeper dive and saying, what were we unable to do last year with the legislation, what do we need to tweak?' because obviously, we didn't get something right," he said.

But providers say change needs to happen soon before the public health emergency, put in place during COVID, ends. The policy allowed for more people to qualify for Medicaid and many of those families will be looking for commercial insurance.

"The end of the public health emergency is a ticking time bomb for the mental health crisis," Bianucci said. "You are going to have up to 20 million Americans, and half a million Coloradans, coming off Medicaid and on to a commercial insurance network. Those commercial insurance networks are already stretched thin. So the explosion of unmet mental health needs, once this happens, will be catastrophic."

With Anthem being one of the largest insurance providers in Colorado, providers worry it will be the go-to option for many of those families leading to more disruptions in care and even longer waits.

"You've got to kind of think about what are those domino affects you are creating that go further down then just maybe this one paperwork piece," Vinson, one of the mothers, said.

Anthem says that since June 2022, 90% of credentialing has been completed in less than 30 days. CBS Colorado asked for data to show that was the case and what the wait times were for the other 10% and we did not receive a response.

Providers also raised concern around Anthem's reimbursement rate which they claim is one of, if not the, lowest rates of all the commercial insurance companies. Many of the clinics and professionals we spoke with say they have not had an increase in nearly a decade.

Anthem did not comment on those claims, saying that rates are confidential. Their full statement reads;

Anthem Blue Cross and Blue Shield believes behavioral health is critical to the whole health of a person. That's why we've worked to expand our network of nearly 10,000 behavioral health professionals in Colorado as part of our ongoing efforts to increase access to care. Additionally, we're building capacity by introducing innovative programs and services, such as virtual access to care.

As we work to enhance our network, it is essential to confirm each provider is licensed and credentialed to ensure our members receive high quality, effective care. This process can take time and we are working to complete credentialing of new providers as quickly as possible. Since June 2022, 90 percent of credentialing has been completed in less than 30 days. Should any provider have a different experience, we urge them to reach out to us (COProviderRelations@carelon.com) so we can work through the matter. We also utilize an 'open network,' which means we will offer an agreement to any qualified behavioral health provider that requests to join our network.

The Colorado Division of Insurance is now asking providers to reach out with their concerns or file an official complaint. You can do that by calling, emailing or visiting their website. You can call 303-894-7490 or 800-930-3745, email DORA_Insurance@state.co.us or visit the agency's website, doi.colorado.gov.

SECTION: Eye on Mental Health