Medicare patient claims they were abruptly cut from mental health services - WMSN Fox 47 Madison

MADISON, Wis. - A Medicare patient who wanted to remain anonymous for privacy concerns said she was abruptly cut off from mental health services she was seeking at Journey Mental Health Center. For purposes of this story, we will call her Cara.

"If I don't get the outpatient services to support me, I end up in a hospital," Cara said.

Cara deals with post-traumatic stress disorder, bipolar disorder and anxiety. She said she had been a patient with the Journey Mental Health Center for the past five years, but last month was cut off from its services.

"She said all Medicare patients were being discontinued from Journey. I asked, 'Effective when?' She said, 'Today.'"

Cara said her insurance has stayed the same for the past five years and she wasn't given any notice that her services would be cut off.

She said she's been without therapy for a month now, something she said she needs on a weekly basis.

Journey Mental Health Center Chief Clinical Officer Tanya Lettman-Shue responded to some of Cara's concerns.

"If they have a change in their insurance carrier, we will work with them and transition them," Lettman-Shue said. "It is not a standard practice that a consumer would show up and be told that day that they would have a final session."

Cara said there was no change in her insurance.

"I feel abandoned," Cara said. "It's a scary feeling that I'm left out there alone."

Lettman-Shue said there's several reasons why Medicare patients may see this happening at Journey Menthal Health Center. Lettman-Shue said for those who have Medicare with an HMO supplement plan, they have to seek services from an in-network preferred provider. To get immediate crisis services, you do not need to have insurance and can still seek help through Journey Mental Health Center. However, Lettman-Shue added that Journey Mental Health Center is a nonprofit organization and sees about 12,000 patients per year in Madison. She said without limiting the number of Medicare patients they see, other patients will end up making up for the cost.

"We have some of the lower Medicare and Medicaid rates in the U.S. Oftentimes, people are put in a position where they are looking at making ends meet, and so they have to limit how many Medicare consumers they can see."

According to an article written by the former executive director of the National Alliance on Medical Illness of Dane County, "Qualified Medicaid providers are paid for each covered service. Currently, the fee-for-service rate paid by Medicaid is 50 cents on the dollar. Over the years, there's been little increase in the reimbursement rate even though the cost for delivering mental health services continues to rise. With this in mind, providers like Journey Mental Health have faced significant financial losses."

Cara said that considering the growing issues surrounding mental health, "Journey should have their patients' health in mind versus their pocketbook."

Cara said her prescriber for the medications she got through Journey gave her a three-month supply to bridge the gap, so she could have time to find a new provider.

Lettman-Shue knows that for people like Cara, that's not an easy task.

"Oftentimes, that can take weeks or months," Lettman-Shue said. "If it's about a medication change, our doctors will oftentimes bridge their medication until they can get in to see another prescriber."

Cara said her mental health concerns are not just about her medication being covered for three months. She said it is imperative she sees a therapist and goes to support groups every week to keep her mental health in check. Cara added even though her prescriber gave her a three month supply of her medication, it doesn't make the process of finding a new provider any easier.

"There's a severe psychiatric shortage here in Madison, plus there's a lot of psychiatrists that won't take Medicare," Cara said.

In the meantime, Cara said she is speaking on behalf of others who may be facing the same struggle in finding someone to help. Cara is hoping she can find a way to make it back to Journey Mental Health Care.

"I'd love to go back to Journey. I have made so much progress in the last five years," Cara said.

Lettman-Shue said she is working to make the transition for any other Medicare patient as easy as possible and patients can reach out for help or suggestions for preferred providers.

For those needing assistance, the National Alliance on Mental Illness of Dane County is able to provide guidance and resources for those who need help finding a provider for clinical services.

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