Published on Jun 27, 2023
LifeStance Health (LFST), a nationwide roll up of outpatient mental health clinics, has, in at least some clinics, installed gatekeepers who demand patients pay whatever the company’s error-ridden billing system shows as outstanding—even if it’s wrong—as a precondition to seeing their therapist, according to an ongoing Capitol Forum investigation.
The Capitol Forum has obtained a distressing video (available here) recorded by a patient who experienced two consecutive cancellations of weekly appointments by a LifeStance gatekeeper. The patient, who is not being identified to protect their privacy, agreed to allow the publication of a redacted version of the video to shine a spotlight on the treatment disruptions and harm to patients caused by LifeStance.
“It has been nothing but roadblocks, run arounds, and incompetence,” the patient recounted to The Capitol Forum.
“First, they refused to file my insurance correctly, constantly telling me I owed money for services my insurance covers. They then threatened to send the bill to collections, so I paid a total of $820 for four months of service. Now my insurance is billed properly, I paid the $820, yet my patient portal still shows a balance of $860 due.”
“Before every one of my appointments since March, my telehealth appointment is pre-empted by the front office saying they can’t allow me to see my doctor because I have an outstanding balance. Except, I don’t. I paid it off. I have the receipts and bank statement to prove it. Front office tells me to call billing. I call billing, and they say I have paid my balance in full and ‘the research team will look into it.’ A month passes, I have my next appointment, and once again, the front office tries to collect $800 more from me. Turns out, I actually never owed that $820 because they filed my insurance wrong. Not only did their incompetence cost me $820, but they actively are trying to get it again from me, when in actuality they owe me a refund,” they said.
Not only did LifeStance repeatedly try to coerce the patient to pay money they don’t owe, but the company also blocked their access to mental health care.
“Stop depriving me of care because you all aren’t doing your job!”, the patient demanded in the video. “What is wrong with you all? Fix my account!”
The LifeStance mission is “improving access to trusted, affordable and personalized mental health care,” according to the company’s securities filings.
Intentionally blocking eligible patients from accessing needed mental health care to coerce payments on a balance that is possibly incorrect is highly incompatible with the company’s stated mission.
“I have waited for this appointment to address my depression and thoughts of self-harm only to be told the day of my appointment that I cannot have it because of their own [billing] issues,” the patient told The Capitol Forum after the second cancellation.
“Gatekeeping, when a patient is in dire need of help, ought to be flexible and attentive to patient need,” Dr. Arthur Caplan, head of the division of Medical Ethics at NYU School of Medicine, told The Capitol Forum.
In the opinion of Dr. Caplan, “When a company has billing issues and knows it, the duty to desperate patients to provide help despite possible billing errors is even stronger. LifeStance is dealing with very vulnerable patients with mental illnesses, but this video makes clear that their needs may be secondary to their ‘pay to play’ business model.”
LifeStance did not respond to a request for comment.
Gatekeeping practice appears to be widespread. The practice highlighted in the video does not appear to be an isolated incident according to LifeStance healthcare professionals and patients.
A clinician who resigned from LifeStance earlier this year told The Capitol Forum in an interview, “A patient messaged me that LifeStance would not let her make an appointment to see me because she had all this debt. But the debt wasn’t real. The patient’s message said that her balance wasn’t right.”
“A few months later, the patient messaged me to say it was all resolved after she blasted LifeStance on social media and someone posted a different phone number for the billing department for her to contact where she was able to get her balance corrected,” the clinician added.
Several patients have posted online complaints accusing LifeStance of blocking their access to mental health care due to incorrect amounts owed.
“They keep trying to charge me over $400 even though I DO NOT HAVE A DEDUCTIBLE….Today, I had one of the people in the front office jump onto my call with my provider to let me know that I could no longer make appointments with him until I paid my bill…really???,” a patient wrote in a Google review.
Another reviewer posted, “We are being ghosted by LifeStance billing regarding incorrect insurance billing on their part…Our provider will not cover any additional services until this situation is corrected, so we are having to go without services while we wait and wait and wait.”
Patient in video demonstrated that amount owed was erroneous yet was denied care. In the video, a LifeStance gatekeeper is heard repeatedly stating she is following “the protocol per my office manager, either we collect and clean the account or we reschedule the appointment until the patient is able to resolve the issue.”
However, the amount LifeStance sought to collect was an $880 balance the patient had disputed several times with the LifeStance billing department. The patient recounted that the billing department agreed that the balance shown in the system was not correct, that nothing was owed, and that the account would be fixed.
The patient explained to the gatekeeper that the balance had been paid already and was in dispute. The patient had complied with the same gatekeeper’s request the previous week that the patient email proof of payments to a specific email address.
LifeStance’s own patient portal confirms the patient has been remitting $20 copayments, as the video shows. However, it appears that those payments were applied to the incorrect outstanding balance, making it appear as if the copayments were not being paid.
“Sometimes copays would be applied to other visits if the patient had a balance,” a former LifeStance administrative employee who left last fall told The Capitol Forum. The billing department would “just pick and choose” how to apply funds collected from patients, the former employee said, adding “That used to be a whole mess.” Other former employees confirmed the haphazard payment posting process by LifeStance’s billing department.
According to the video, LifeStance did not correct the patient’s account after the gatekeeper cancelled the prior week’s appointment. So, the following week, on the day of the appointment when the video was recorded, the gatekeeper cancelled that appointment too.
After the second appointment was cancelled, the patient called LifeStance to submit a compliance complaint.
“I filed a complaint yesterday,” the patient told The Capitol Forum on June 8. “They actually called me today, which is the first time that’s happened. I guess I lit a fire under them. They’re still investigating what happened to that $800 I paid. Even though I have the receipt, LifeStance has no record of receiving that money. They said I should get a refund once they finish the investigation.”
Several former LifeStance administrative employees who worked in different states suggested to The Capitol Forum numerous factors that contributed to the systemic mismanagement of patients’ financial accounts: unwarranted and excessive fees applied to patients’ accounts, overcharges to patients’ credit and debit cards, charging patients for amounts paid by insurance, bungled insurance claim processing, and illogical payment posting.
As previously reported by The Capitol Forum, once LifeStance takes over a facility, it can descend into chaos, mismanagement, high employee turnover, and severe understaffing that negatively impact clinicians and administrative employees. Combined, these factors can create dangerous treatment disruptions for vulnerable mental health patients.
“This looks like a business enterprise that is completely falling apart and not acting with reasonable care toward extremely vulnerable consumers,” opined Dr. Caplan in an interview with The Capitol Forum discussing previous Capitol Forum reporting on LifeStance.