UnitedHealth’s Optum Sticking Behavioral Health Docs With Payment Delays, Threatening Patient Care and Clinician Solvency

As my colleague Joey Rettino wrote earlier this week, health insurance companies’ provider networks are plagued with ghosts, especially when it comes to mental and behavioral health. Numerous studies have shown that in many cases, more than half of the providers listed are not seeing new patients or are no longer in the insurers’ networks. But patients aren’t the only ones getting the short end of the stick from companies like UnitedHealthcare.  The country’s mental health providers are getting shafted, too.

According to a complaint first published on ClearHealthCosts by Jeanne Pinder, The American Psychological Association and the American Psychiatric Association wrote in a letter to Dr. Amar A. Desai, CEO of UnitedHealth Group’s Optum Health, that Optum’s pre-payment reviews (PPRs) are "unsustainable," and that the “enormous financial and administrative strains" are driving some clinicians to stop accepting insurance altogether. 

PPRs are a process in which health insurers or their vendors or sister companies, like UnitedHealthGroup’s Optum, require physician practices to submit extensive documentation — such as medical records and treatment notes — before they’ll pay claims for services rendered. For clinicians, this adds administrative burdens and payment delays.

Small practices with limited financial and administrative resources are especially vulnerable. Instead of being able to focus on caring for patients, they’re drowning in paperwork, waiting months to be paid, if at all. The joint letter reads:

American Psychological Association Services and the American Psychiatric Association write to urge that you cease nationwide the recent barrage of prepayment reviews (PPRs) that Optum has inflicted on our members. We have grave concerns about how – during the nation’s continued mental health crisis and heightened concerns about patient privacy – these PPRs may disproportionately impact mental health patients’ access to care, and unnecessarily put their privacy at risk in a way that we believe violates the HIPAA minimum necessary rule. These PPRs have even caused some patients to stop treatment.

The financial strain is so severe that 44% of psychologists surveyed said these delays threaten their solvency. This is not just a minor inconvenience — it's a direct attack on mental health care delivery at a time when the nation is in the grips of a mental health crisis. 

This bureaucratic hurdle is another way UnitedHealth and other Big Insurance corporations are violating the Mental Health Parity and Addiction Equity Act, which requires them to treat mental health care the same as physical health care. UnitedHealth knows this is the result of PPRs, in fact they are happy with this result because it keeps them from having to actually pay for their customers’ care. 

UnitedHealth Group, via Optum, is making it nearly impossible for clinicians to keep their doors open and serve their patients. As Pinder points out, patients are pausing or stopping treatment because of these delays. When clinicians are forced to navigate Optum’s labyrinthine reviews instead of focusing on their patients’ care, everyone loses.