In a nation deeply embroiled in a debate over access to mental health services, you might think that making it as easy as possible to access mental health care would be a priority. Thanks to numerous discussions unfortunately sparked by acts of mass violence, Americans seem generally committed to the idea that addressing mental health problems should be a national issue. In some senses, strides are being made, but there’s a glaring and fundamental problem: psychiatrists are more likely to refuse insurance than other care providers, creating a significant barrier to care.
As the United States debates over whether mentally ill people should be forced into treatment and compelled to follow a number of discriminatory laws (such as bans on gun ownership), a few victories are emerging for mental health. For example, mental health parity was a key component of the Affordable Care Act: insurance companies must treat mental illnesses like any other health condition, and they cannot refuse to cover them. The pre-existing condition coverage mandated as part of ACA also benefits mentally ill people, many of whom have been struggling for years with their illnesses and who may have had difficulty getting insurance as a result.
Health insurance reform, in other words, has taken some significant moves when it comes to helping people access mental health services. Insurers now have to pay for medically necessary therapy, medications, and other treatment options as determined by a patient’s care team.
But that doesn’t mean psychiatrists need to accept that insurance.
This has been a historic problem with mental health professionals, many of whom became so accustomed to having claims rejected that they ended up deciding not to take insurance at all. Processing insurance claims can get expensive, and adds considerably to the costs of maintaining a practice — a big issue for psychiatrists, many of whom practice independently out of their own offices, and thus lose valuable time to medical billing. Accustomed to repeated rejection of claims for psychiatric care, even from insurance companies that were supposed to cover it, some turned to all-cash practices, sometimes with a sliding scale for patients who couldn’t afford the full price.
For mentally ill people seeking therapy, the already daunting task of finding a therapist they’d feel comfortable with was made even harder by the fact that they first had to find a therapist their insurance would cover, and then they had to see if that therapist would accept insurance. In a study published in JAMA Psychiatry last month, researchers found that approximately 55% of psychiatrists, compared with almost 90% of other care providers, accepted insurance, and similar statistics were seen with Medicaid — a government program heavily relied-upon by severely mentally ill people, who are at increased risk for poverty and unemployment. Acceptance of private insurance coverage had dropped significantly over the last decade, illustrating that the issue is getting more acute.
Psychiatry appointments can cost $100 a session or more, depending on the region and the therapist, and some people need therapy two days or more a week, with costs quickly running into the thousands each month in some cases. For people undergoing intensive outpatient therapy, a key component of managing mental illness for some mentally ill people, the high cost of psychiatric therapy can be a significant barrier to appropriate treatment, and a stumbling block to recovery, developing coping skills and learning to manage a challenging mental illness.
Even as the United States is recognizing a mental health crisis, the very professionals needed at the front lines to address it are reluctant to accept the insurance many mentally ill people are relying on to pay for care.
This creates rather a stalemate in the pipeline to good health: can mental health professionals shift their attitudes on accepting insurance?
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