Published on Aug 24, 2023
Payers that contract with LifeStance Health (LFST) frequently send questionnaires to LifeStance to inquire about provider and appointment availability for a specific insured member who needs mental health care.
But in the case of TRICARE and Anthem Blue Cross Blue Shield in certain California locations, LifeStance had imposed a complete “restriction” on scheduling any new patients for those payers.
Despite this, LifeStance intake coordinators were instructed and encouraged to mislead insurance representatives by providing phantom availability options—provider names and appointment dates and times that LifeStance would not actually honor when the patients call in to confirm, according to an ongoing Capitol Forum investigation.
Staff were forbidden from informing payers and patients that no appointments would be scheduled for new customers from those payers during the “restriction” period.
That is, rather than tell TRICARE and Anthem and their insured members that certain patients would not be seen, intake coordinators were instructed to mislead both the payer and the consumer who was seeking mental health care. In the case of TRICARE, the consumers are active duty servicemembers, survivors of deceased military members, Medal of Honor recipients, the dependents of these individuals, as well as some veterans with service-connected disabilities.
As part of this investigation, The Capitol Forum reviewed company documents, Slack messages exchanged between LifeStance employees, and spoke with current and former LifeStance employees.
LifeStance did not respond to request for comment.
Anthem and TRICARE restrictions. The restriction on scheduling new Anthem patients was imposed for an estimated six or fewer months in mid-2022, according to two sources. The restriction on new TRICARE patients lasted much longer, over a year from at least April 2022 until earlier this month when the restriction was lifted, according to company documents reviewed by The Capitol Forum.
“We cannot schedule new Tricare patients if Tricare is their only or primary insurance,” a document states (emphasis in original). LifeStance staff were instructed to put new TRICARE and Anthem patients on a waitlist, even though no appointment would be made during the hold.
“If a new Anthem client (meaning they have never been seen by us before) [calls], please tell the client, ‘Unfortunately, we do not have immediate availability for the services you are seeking. I am happy to place you on a waitlist should we have a cancellation or a clinician’s schedule opens up,’” directs a call script provided in the same document (emphasis in original).
“Provider availability was given to the insurance representatives knowing, that if a TRICARE patient called to schedule, we were going to turn them away,” explained one source.
The reasons for the near total restrictions on new patient scheduling for Anthem and TRICARE are not entirely clear. Two employees who worked in a facility in which the restrictions were enforced hypothesized that it was due to low reimbursement from TRICARE and Anthem Blue Cross.
One opined, “Some insurance companies did not pay LifeStance enough, but LifeStance doesn’t want the insurance companies to know that we weren’t scheduling their patients. It is morally and ethically wrong.”
The source continued, “So we were supposed to lie to insurance companies and give them fake dates when they were trying to get mental health care for a member. Then that patient would call to confirm an appointment selected from the options we gave their health plan. And we’d have to lie and say that appointment just got taken and there’s no availability. But in reality, we never would have scheduled them. Never. They don’t know that. We don’t tell them that.”
LifeStance “pruned” the bottom 25% of payers this year, according to comments by company president and COO Danish Qureshi during earnings calls this year. It is not known whether the company’s pruning process included blocking payers’ members from scheduling new patient appointments.
For the patients whose payer was “restricted,” LifeStance employees were instructed, “You do not need to create a chart for these clients,” according to a document reviewed by The Capitol Forum. According to one source, this “means do not create an account for them in our system. The reason for that is LifeStance didn’t want us creating accounts for people we weren’t going to schedule so it didn’t affect our new patient scheduling metrics.”
For some current and former LifeStance employees, the treatment of consumers who were covered by TRICARE was incredibly problematic, with one estimating that approximately one-third of the calls, emails, and online requests to schedule an appointment with a LifeStance therapist received each day was for someone covered by TRICARE.
In California, LifeStance operates roughly 50 offices with over 630 providers offering in-person and remote outpatient mental health services. One of LifeStance’s larger practices is near San Diego, which has a large military presence.
In short, active-duty military members and their family members were told there was currently no availability and left to languish on sham waiting lists when in some cases they urgently needed mental health care, according to current and former employees The Capitol Forum spoke with.
Several intake coordinators “are military or retired military who take that to offense because the employees are directed to lie to the military community,” one source said.
LifeStance’s misleading availability practices may lead payers to unintentionally violate mandates under the 2008 Mental Health Parity and Addiction Equity Act (MHPAEA). MHPAEA is a federal law that generally prevents group health plans and health insurance issuers that provide mental health or substance use disorder benefits from imposing less than favorable benefit limitations on those benefits compared to medical/surgical benefits.
Improving access to mental health care and tackling the country’s mental health crisis is a priority of the Biden administration. The administration last month proposed a rule to “reinforce the MHPAEA’s fundamental goal of ensuring that families have the same access to mental health and substance use benefits as they do physical health benefits.”
One specific provision in the proposed rule would require health plans to “evaluate the outcomes of their coverage rules to make sure people have equivalent access between their mental health and medical benefits. These analyses are meant to show plans where they are failing to meet their requirements under the law,” according to a White House fact sheet on the administration’s “action to make it easier to access in-network mental health care.”
However, any analyses by health plans contracted with LifeStance are likely to yield unreliable results since the LifeStance inputs are likely corrupted with faulty provider and appointment availability data.
TRICARE and Anthem did not respond to request for comment.
