Reprinted from NASW Tips & Tools for Social Workers
Mirean Coleman, LICSW, CT Director of Clinical Practice
NASW members recently informed the association of notices of overpayment from the insurer, Optum/United Behavioral Health, and its Optum Recovery Service Team. An overpayment occurs when an insurer pays more than is expected for a health service. It can happen for many reasons including:
Incorrect calculations
Billing errors
Misunderstanding between the payer and provider
In the Optum Recovery Service situation it may be due to incorrect calculations. Optum has reported that they paid clinical social work providers 100 percent of the psychologist rate when they should have been paid only 75 percent of the psychologist rate. As a result, they are requesting overpayment requests of 25 percent from their clinical social work providers. The Social Security Act, Section 1833(a)(1)(F) confirms that clinical social workers are paid 75 percent of the psychologist rate. It is unclear whether the overpayment includes in-network providers and/or out of network providers. The amount requested ranges from a hundred to thousands of dollars.
NASW encourages its members who received an overpayment request to file an appeal. In the meantime, NASW will:
Seek legal consult
Request an appointment with Optum’s leadership to resolve this matter
Explore alternatives to advocate for its members in this matter.
NASW members who have questions about Optum’s overpayment requests may email clinical.practice@socialworkers.org