We thought we had this problem licked with the historic passage of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008, a law which banned insurance companies from discriminating against people with mental illness.
Unfortunately, insurance companies just found new ways to deny patients care for their mental health condition — through rationing access to service providers.
America, home of the world’s most convoluted and complicated healthcare system in the world, has to also be one of the worst mental health care systems. Because healthcare is actually regulated state by state, it is up to individual states to police insurance companies and their actual practices (versus what they say they do).
That means there are 50 overworked, underpaid attorney general’s offices who have more important things on their plates than to ensure insurance companies aren’t trying to get around the laws by rationing mental healthcare in their state.
PBS NewsHour recently reviewed the situation in just one of those states, California:
NATALIE DUNNEGE (person seeking mental health treatment): Blue Shield sent me a list, like, I should be fine, just make a few phone calls, I will find somebody. I called everybody on this list. Only one place called me back. I have to be as emotionally healthy as possible, so that I can be there for Strazh, because he has good weeks and he has bad weeks.
APRIL DEMBOSKY (interviewer): Turns out that Natalie’s experience is by no means unique. I called 100 psychologists in San Francisco who take Natalie’s insurance. […]
Half said they’re no longer taking insurance or new patients, and a quarter never even called back. […]
Only eight had appointments outside of normal work hours. I contacted Blue Shield for an interview, but they declined. Instead, they sent a statement saying that the provider has to notify Blue Shield if they’re no longer taking new patients. They also said California is facing a shortage of mental health providers.
LOL! Blue Shield of California is apparently living in a dream world — one of their own creation. They have the audacity of blaming providers for the lack of access to professionals in their own network! Isn’t it incumbent upon the provider of the actual insurance — Blue Shield — to keep their provider list up-to-date, and ensure it has enough professionals to cover the lives under their care? It seems like something out of the 1980s to expect providers to contact each insurance company panel every time they are open or closed to new patients (as though clinicians had the time to telephone all these companies every time they have an opening).
Blue Shield — and virtually every insurance company out there — will blame everyone except themselves for the impossible situation most Americans face when they try to find a new mental health professional. We get stories like this every week in our inbox about patients desperately seeking care — even though they have great insurance coverage!
Here are the problems that need to be addressed.
Not Enough Providers in Their Panel
Insurance companies make greater profits when they keep their provider panels limited in numbers. Fewer providers mean fewer people able to seek services and to actually get them. It’s a simple and effective way to ration mental healthcare, all the while innocently proclaiming you’re providing the service coverage required, according to some financial, metric-driven ratio. Insurance companies can safely ignore the reality on the ground by pointing to statistics.
Not Enough Open-to-New-Patients Providers in Their Panel
Insurance companies who claim they don’t know who’s open to new patients and who’s not are purposely burying their head in the sand. If you don’t know the status of the independent contractors you pay for services, you’re not a very good or effective company. If I didn’t know the status of my writers and editors, I’d be out of business within a month. The only reason insurance companies remain in business is because their customers — patients looking for services — have no recourse to this state of affairs. They complain to the company, and the company points the finger to somewhere else. They could complain to regulators in their state, but patients just want to be seen — they don’t want to go through the hoops of dealing with government bureaucracy.
Providers Who Never Call Back
A friend of mine suffering from depression was looking for a new psychiatrist a few months ago. She called every single psychiatrist listed in her insurance company’s provider list. Over 90 percent of those providers never called her back. How frustrating and hopeless it must feel to someone already dealing with depressive symptoms to be rejected by the vast majority of professionals they try to reach out to.
Clearly the current system is broken. Having to reach out to dozens of professionals individually, hoping to hear back from one or two of them, is not a very efficient or compassionate way to provide services to someone in need.
Shortage of Mental Health Providers?
Insurance companies like Blue Shield point to a “shortage of mental health providers.” That is simply a lie. There is only one kind of mental health professional where the demand has outstripped the supply, and that is in psychiatry. The dozen or so other kinds of mental health professionals are readily available in nearly every state (and definitely in California).
Part of the problem is that insurance companies don’t want to reimburse mental health providers at competitive rates — instead regularly cutting their reimbursement rates for the best trained, most experienced professionals, such as psychologists. It’s not surprising a company would complain of “not enough providers” when what they really mean is, “not enough providers who will agree to our pitiful reimbursement rates for psychotherapy services.”
We asked Blue Shield of California for comment to these concerns, but they declined to be interviewed for this story.
Time for a Change
How many more stories do we have to hear about the lousy services provided by supposed excellent healthcare companies like Blue Shield before action is taken?
Why do Americans continue to believe they have such a great mental healthcare system, when by any standard of importance, it appears to be one of the worst ones in first-world countries?
When are companies going to stop passing the buck and blaming their very own providers for the sorry state of affairs? And when are customers going to rise up and demand the services that they (or their employer) are paying for?
Read the full article: Why even insured Americans struggle to get mental health care
from World of Psychology http://psychcentral.com/blog/archives/2016/11/11/got-insurance-youre-going-to-have-a-frustrating-wait-for-rationed-mental-health-care/
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