An insurance snafu cost a woman mental health treatment for weeks – The Boston Globe

To her great relief, DeBonis found an affordable plan offered by Tufts Health Plan that listed on its website the names of her therapists as being in-network.

She signed up and paid her first monthly premium, thinking there would be no interruption in her therapy.

But then the managers of the group practice that included her therapists said it would not accept her insurance, despite Tufts saying on its website that they were in-network.

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Sheila’s mother, Eileen Lawlor, of Quincy, jumped in to help, spending long hours online and on the phone trying to remove bureaucratic obstacles that were blocking her daughter’s treatment.

On two occasions, Lawlor had extended phone conversations with Tufts representatives who checked and rechecked the status of the two therapists and insisted they were in-network, just as the website said.

The Tufts representatives gave Lawlor their names and call reference numbers and urged her to have managers of the group practice call them to verify.

But LifeStance Health, which manages DeBonis’ therapists, seemed equally sure the therapists were not in-network.

LifeStance, one of the nation’s largest providers of outpatient mental health care, recently took over the South Shore group practice that included the two therapists.

Tufts, too, is growing. It recently merged with Harvard Pilgrim Health Care to form Point32Health, which has more than 2 million members, the second-biggest health insurer in the state after Blue Cross Blue Shield of Massachusetts.

While Lawlor toggled back and forth between Tufts and LifeStance looking for a solution, DeBonis went without treatment for weeks.

Finally, unable to clear the impasse, Lawlor contacted me.

“To say that this is causing my daughter great anxiety is an understatement,” she wrote to me. “We are at wit’s end.”

What happened in this case is an example of how the actions (and inactions) of large insurers and large corporations can have serious consequences for people like DeBonis.

When it became apparent to Tufts and LifeStance that DeBonis was missing needed treatment, someone should have stepped forward to figure out why and fixed it.

Here’s some of the back-and-forth:

In a Feb. 14 e-mail, a LifeStance manager told Lawlor that he had confirmed “with my directors” that DeBonis’ therapists were not in-network and that the Tufts website was apparently wrong.

But Lawlor then talked to a Tufts representative on the phone who was so sure the therapists were in-network that she offered to call LifeStance while Lawlor remained on the phone. But the hold time trying to get through to LifeStance was too long, and the representative gave Lawlor her information to pass along to LifeStance.

Pressed again for more information, the LifeStance manager responded in a second e-mail to Lawlor on Feb. 24 that the company’s “benefits verification team” had determined that the therapists were not in the Tufts network.

The LifeStance manager said the company’s contracts with Tufts did not include the particular plan DeBonis was on, “Tufts Health Direct.”

“Our clinicians cannot bill visits under Tufts Direct plans,” the manager wrote.

After receiving that e-mail, Lawlor called Tufts again, and was assured by a different representative that DeBonis’ therapists were in-network.

Lawlor wrote back to the LifeStance manager that Tufts had confirmed her information and that “you should be accepting this insurance without question.”

After getting no further response, Lawlor turned to me.

A day after I got involved by making inquiries of Tufts and LifeStance, Tufts e-mailed me a statement clearing the way for Sheila to resume her therapy.

“We have been in contact” with Sheila to let her know that her therapists “are in network” and that she can see them “at this practice,” the Tufts statement said.

“We have also been in touch” with LifeStance and this issue has now been resolved,” Tufts said.

So where had things gone wrong? Turns out that Tufts and LIfeStance were in negotiations on a new contract but had not finalized it when Tufts prematurely said on its website that DeBonis’ therapists were in-network.

The contract has since been finalized but it was not when LIfeStance told DeBonis that her therapists were not covered.

Later, Tufts acknowledged its mistake, saying it had “incorrectly listed” the therapists as in-network.

“Upon learning of this issue, we worked quickly to update our contract with LifeStance to add this product and these providers were added to the Tufts Health Direct network.

“We apologize for the inconvenience this caused our member and we are pleased it has been quickly resolved,” Tufts said.

DeBonis and Lawlor said, to them, it didn’t feel “quickly resolved.” It felt exhausting and long overdue, they said.

Got a problem? Send your consumer issue to sean.murphy@globe.com. Follow him on Twitter @spmurphyboston.