Thursday, December 9, 2010

BlueCross BlueShield of Illinois Pre-Certification Procedures: Implications for Counselors, Social Workers and Psychologists.

We had previously commented to our membership that BlueCross BlueShield of Illinois (BCBSIL) decided to rescind its pre-certification requirement for 2010. See the IMHCA Blog June 10, 2010. ( Also our past member newsletter.

We heard from many counselors that they had concerns about the changes taking place. Mental Health Professionals in Illinois have been notified that beginning January 1, 2011, they will be required to request preauthorization for all covered behavioral services. They will need to show medical necessity. See Blue Review (Page 5)

NASW-IL, the Illinois Psychological Association as well as IMHCA and our members have concerns about this new requirement including:
• A possible violation of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008 that became law in October of 2008; See more details on Mental Health Parity at :
• Whether the pre-authorization will be burdensome to care and limit access to service, thereby again violating the MHPAEA of 2008; and
• The unclear nature of the required Outpatient Treatment Request (OTR) form to evaluate if the requested services are medically necessary.
If you are a BCBSIL provider, here are some action steps for you to undertake:
• Contact your BCBSIL Network Consultant regarding these concerns;
• Advise your clients to call BCBSIL as well as their employers;
• Let the professional association you belong to (IMHCA) (NAWS-IL) (IPA) know whether or not your clients experience any limited access to care due to the new pre-certification requirement.

The NASW Illinois Chapter has notified the Illinois Department of Insurance and is currently scheduling a meeting with them. We are working with them and the Illinois Pyschological Association and any other allied mental health professional associations on this issue. We will keep our members updated through our member blast emails.