Families in Colorado want help – adults and their children have mental health issues but can’t get support when they need it.

“I’m so desperate to find care for her,” a mother, who asked to remain anonymous, told CBS News Colorado.

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A Colorado mother, who asked to remain anonymous, speaks to CBS News Colorado’s Karen Morfitt.

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According to the 2021 Colorado Health Access Survey, nearly one in four Colorado residents age 5 and older report having had eight or more days of poor mental health in the past month; a jump of more than 15% compared to 2019.

“I shouldn’t have to wait until my child is in full crisis mode to be able to unlock care for them based on my insurance,” Nicole Vinson said. She’s been trying to babysit her daughter for months.

These are just two of the mothers willing to share their experience, but the providers we spoke with say their waiting lists are getting longer every day.

“We currently have over 120 children on our waitlist awaiting services, some of whom have been on this waitlist for almost a year,” said Blair Skinner, director of Early Childhood Wellness Place in Broomfield.

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Blair Skinner, Director of Early Childhood Wellness Place

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

“We tell customers who have Anthem, ‘you’re going to be waiting two to three times longer than everyone else, unless you choose to waive your insurance and pay for yourself,'” Skinner said.

In Centennial, Kelly Bianucci, president of the Child and Family Therapy Center in Denver, discusses the same issue with the same company.

“We started limiting our anthem waitlist to 80,” she said.

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

“We’ve had four clinicians on our team since last summer and we haven’t been able to add a single one to our Anthem contract,” Bianucci said.

According to them, providers are also limited by Anthem on the staff they can use to see these patients.

“I have the three professional licensure candidates who are fantastic and they can see our Medicaid clients, they can see clients who have certain private insurance, but the largest percentage of people on our list of Waiting right now have Anthem Blue Cross and they won’t allow anyone unless they’re fully cleared to see their customers,” Skinner said.

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Kelly Bianucci, president of the Child and Family Therapy Center of Denver, left

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She compared these candidates to residents of a hospital or pre-licensed lawyers.

“Confirming that each provider is licensed and accredited is critical to ensuring our members receive high-quality, effective care,” an Anthem spokesperson said in part. “This process can take time and we are working to complete the accreditation of new suppliers as quickly as possible.”

“It’s very admirable to say, ‘all of our vendors are fully licensed and we only want the best for our customers,’ but that really limits the number of vendors that can see those customers,” Skinner said.

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

“I’ve literally called dozens of providers, so the big agencies and individual therapists are trying to find a provider to see her, someone she can get in touch with and she’s been told ‘not to agree to new customers”, “private payment only”, “have a large waiting list. I haven’t found anyone to take care of her,” a mother told us.

Bianucci says Anthem can list a number of providers for its members, but without openings she says it creates what’s called a “ghost network.”

“These families are calling, they’re not able to find that, so if there are really enough providers, how do we connect members with them? We’d like to refer them directly to those options,” a- she declared.

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 to treat mental health like any other medical condition, and the Colorado Department of Insurance is responsible for 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 with networks and accreditations.

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Cara Cheevers, director of behavioral health programs at the Colorado Division of Insurance

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“When we talk broadly about the need for mental and behavioral health, does that make you want to put it at the top of your to-do list?” asked CBS Colorado reporter Karen Morfitt.

“If we get complaints, the short answer is ‘yes.’

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

“A consumer can get out of the network at an in-network rate after seven days, for example, if there’s no supplier who can get them within the required 7 days. There are off-net allowances for – basically for a inadequate network in this case,” she said.

Although some insurance companies already do this, we asked if all should be required to include licensure applicants in their contracts. She said it’s an issue that multiple stakeholders should weigh in on, but thought it was worth considering.

“I think we as a state, led by Governor Polis – we’re really thinking about creative ways to expand the supplier base. And in terms of pre-licensing work, I think that’s is really interesting and potentially creative solution,” she said.

State Rep. Matt Soper, who sits on the Colorado state legislature’s health and insurance committee, said that while they’ve tried to address accreditation backlogs in the past , it was time to re-examine the problem.

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Matt Soper, Colorado State Representative

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“It’s really going back and going deeper and saying, what were we unable to do last year with the legislation, what do we need to change?” because obviously we didn’t do anything right,” he said.

But providers say the change must happen shortly before the end of the public health emergency, put in place during COVID. The policy has allowed more people to qualify for Medicaid, and many of those families will seek commercial insurance.

“The end of the public health emergency is a ticking time bomb for the mental health crisis,” Bianucci said. “You’re going to have up to 20 million Americans and half a million Coloradians, coming off Medicaid and moving into a commercial insurance network. Those commercial insurance networks are already exhausted. So the explosion of need unmet sanity, once that happens, will be catastrophic.”

With Anthem being one of the largest insurance providers in Colorado, providers are concerned that this will be the option of choice for many of these families, which will lead to more disruption in care and even longer waits.

“You kind of have to think about what these domino effects that you’re creating are that go beyond maybe this document,” said Vinson, one of the mothers.

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Nicole Vinson, right.

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

Providers have also expressed concern about Anthem’s reimbursement rate which they say is one of the lowest, if not the lowest, of any commercial insurance company. Many clinics and professionals we’ve spoken to say they haven’t had a raise in almost a decade.

Anthem has not commented on these claims, saying the pricing is confidential. Their full statement reads;

Anthem Blue Cross and Blue Shield believe that behavioral health is essential to a person’s overall health. 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 are building capacity by introducing innovative programs and services, such as virtual access to care.

As we work to improve our network, confirming that each provider is licensed and accredited is critical to ensuring that our members receive high-quality, effective care. This process can take time and we strive to complete the accreditation of new suppliers as quickly as possible. Since June 2022, 90% of accreditations have been obtained in less than 30 days. If a provider has a different experience, we encourage them to contact us ([email protected]) so that we can resolve the issue. We also use an “open network”, which means that we will offer an agreement to any qualified behavioral health provider who applies to join our network.

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The Colorado Division of Insurance is now asking providers to raise concerns or file a formal complaint.

You can do this by calling, emailing, or visiting their website.

You can call 303-894-7490 or 800-930-3745, email [email protected], or visit the agency’s website, doi.colorado.gov.

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