Columbus, OH–Combining a 25-year career in the insurance business with a successful five-year psychotherapy experience, an attorney has gone to bat for Ohio psychologists, winning a $400,000 settlement for them and other health care professionals.
Glenn Karr, who spent most of his legal career in the insurance industry, including Blue Cross and health maintenance organizations, met with Anthem Blue Cross officials in Cincinnati in early 1997 to seek a settlement for mental health providers.
The case hinged on an important detail that had been overlooked by the insurer: Contracts between providers and Anthem required the Blue Cross company to give a 90-day notice of any cut in reimbursements. By failing to give the required notice, Karr maintained the company’s made a legal mistake which had taken $400,000 from the pockets of mental health providers in the state. While Karr had urged the Ohio Psychological Assn. to take the lead position in the case, the reimbursement issue also benefitted psychiatrists and social workers.
“Anthem made mistakes,” Karr said during an interview with The National Psychologist. But, he was quick to point out that the mistakes Anthem made were not intentional, that they “weren’t conscious decisions for people to screw it up.”
Obtaining the $400,000 was the first attempt at representing psychologists against an insurance company by the Ohio Psychological Assn.’s 16-month-old “Project Fair,” which has received a $10,000 grant for 1998 from the American Psychological Assn. During the first year of Project Fair, Karr was paid by voluntary contributions from members of OPA.
The bulk of the $400,000 went to psychologists because there were more psychologists involved in the negotiations with Anthem than other mental health professionals.
Karr estimates that reimbursements from the Anthem settlement ranged from $200 for a solo practitioner to as much as $20,000 for a large group practice. In all 1,300 psychologists were involved in the Anthem settlement, Karr said.
“Laying it on the line”
“My style was to confront Anthem officials. We laid it on the line–that we were prepared to file suit if we couldn’t find an agreement,” Karr explained.
Karr’s “win-win” philosophy meant that “the psychologists won since there were no legal fees involved and Anthem got a lot of good will and didn’t have to pay any legal fees either. A class action in court would have taken years to settle, with the attorneys’ taking at least a third of any settlement and Anthem would have had considerable legal bills.
Under Project Fair, the case was settled in a few months. Another benefit from the non-lawsuit approach is that Karr now has important contacts within Anthem that enables him to cut through red-tape and go directly to the top to get answers to questionable reimbursement issues. He has met with Anthem officials twice since the settlement to continue to build good will within the company.
Karr’s association with OPA began about four years ago when he volunteered for committee work, mainly in the area of insurance and law. He was not reimbursed for his committee work for the first two years.
At age 40, Karr said he went into psychotherapy at the same time he quit drinking and smoking and began to eat a healthier diet. He said he had been drinking and smoking since he was 14 in an effort to deal with painful childhood experiences.
“But, when I started a healthier lifestyle, those memories returned and I decided to seek help from psychologists,” the soft-spoken attorney explained.
Turned his life around
“It turned my life around,” Karr said. “As a result of therapy, I was able to regain my spirituality. I found that psychologists help people recover so they can access the better parts of themselves.”
Karr said he wanted to focus his attention in the area of psychology in order to share his positive experience in therapy with others.
“I have dedicated myself to making sure people have options in terms of the availability of care,” he added. “I decided with my background in managed care and the fact that I was familiar with insurance law would allow me an opportunity to do that.”
“I feel this is what I’m supposed to be doing. I wanted my abuse to have some positive benefits; I wanted something good to come out of it,” Karr said. Psychologists are the healers in society. My goal is to support them.”
He has established a toll-free hotline that allows psychologists to bring problems to his attention. Karr said he looks at all the problem cases and seeks ways to resolve differences between insurance companies and psychologists.
As part of his one-day-a-week work for the OPA’s Project Fair, Karr has met with several managed care and insurance companies to seek ways to resolve the problems early and not wait until it becomes necessary to take legal action in court.
Next project could be more lucrative
He is currently looking at a Cleveland area managed care company where he feels a larger settlement is possible than the one he won against Anthem.
Karr said his law degree in an invaluable tool in getting the insurance companies’ attention. “It helps being a lawyer. I have a club and I can threaten. I say you can either work with me one way or deal with me in another,” he explained. He said it also helps his cause to have access to top insurance officials to solve problems.
“The problem most psychologists have is that they are dealing with some low-level person. I am able to go to the top person with a phone call to get immediate answers,” Karr said.
The attorney also said he is not above using publicity to obtain what he wants.
“I look for mistakes that deal with legal matters, insurance law and contract law,” Karr stated. Insurance companies, he said, “do 95% of their work correctly. I am looking for the 5% where there are mistakes.”
Karr said he has met with the director of the Ohio Department of Insurance, who told him to pass on any information about insurance companies’ not complying with the law.
Karr is currently developing ongoing relationships with other managed care organizations, including Human Affairs International and United Behavioral Health, the latter being the company which holds the contract for 55,000 state of Ohio workers.
Karr said he would like to see the psychology profession get out of managed care altogether and return to the traditional fee-for-service base.
“Putting limits on is wrong,” he said of the managed care industry. “Visits shouldn’t be limited to 12. You are having people with nursing degrees second-guessing people who have earned their Ph.Ds.”
The stigma associated with medical diagnosis is a major problem in managed care, he said. “Managed care now wants higher and higher levels of pathology,” he added.
Karr is also a member of the speakers bureau for the American Mental Health Alliance.
“I am willing to use my own story of recovery if it helps fight the stigma associated with mental health problems and convinces people to get into therapy,” he added.