A Few Words About Insurance

A recent KQED Forum program addressed in some complexity issues pertaining to access to mental health treatment.  The program, “Despite Laws to Increase Access, Many Californians Struggle to Find Mental Health Services,” addresses problems of access for consumers and difficulties providers face who accept insurance for their services.  Given this informative and insightful program, I’m inspired to say a few words about one of the problems of accessing treatment, namely the use of insurance coverage for such treatment.

As a licensed psychotherapist for the last 15 years, and someone who is on insurance panels and offers psychotherapy to patients using in-network and out-of-network insurance benefits, I have had a great deal of experience.  I am committed to offering my services to working- and middle-class people, for whom without insurance coverage access to services would not be possible.

However, there are some real problems being a provider for health care companies that negatively impact therapists’ ability to offer these services.  As the KEQD program emphasizes, one of the major issues is the very low rate of reimbursement health care organizations offer providers.  That rate is significantly lower than the average rate charged by providers in the area.  Over the past 15 years, I have had only one insurance company raise the rate of reimbursement, and that was by $1 an hour.  Given that the rate of reimbursement has not changed over the years, and inflation and the cost of living, particularly in the Bay Area, have continued to rise, I am actually being paid less each year.  Over the years, I have had many hours of continued education and am currently in an intensive training program than spans many years.  None of my experience or training is apparently of concern to the insurance companies in terms of what I am paid by them.  (I should note that as an in-network provider, by contract I am not allowed to charge patients anything other than their co-payments).

And there are other problems related to patients using their insurance.  Many therapists site the amount of paperwork required by an insurance organization.  Not only is the time spent filling out such paperwork not reimbursed, but additional hours, such as telephone contact, is not reimbursed either.  Another major problem is the fact that these insurance companies sometimes conduct clinical reviews which often result in limiting treatment or not authorizing it at all.  These reviews seem completely arbitrary to me: I have had patients using in-network benefits for years without my once being required to conduct a clinical review.  On the other hand, I have had people reviewed and in all cases treatment has been negatively affected.   I have had patients with diagnoses of Major Depressive Disorder and Bipolar Disorder who have had treatment denied by the insurance company.  I have often gone to bat for my patients and initiated appeals of such decisions. And I’m happy to do that for my patients.  I am incensed by the fact that some outside entity – which I believe is motivated purely financially to save money for shareholders – can oversee the treatment I provide to someone I see in my office and with whom I have a close relationship.  The KQED program talks about the use of the term “medical necessity” by insurance companies to deny coverage.  As the reporter points out, determining what is medically necessary in terms of mental health treatment is something very different than in medical issues.  While I have provided insurance companies with diagnoses, a discussion of symptoms, my treatment plan, interventions, goals and signs of improvement, I have often been told that treatment does not meet “medical necessity.”  It is a very frustrating situation, again one I believe is motivated by the financial objectives of the health care organization.

There are other excellent articles available on KQED’s website that further address the problems related to low reimbursement rates for psychotherapists.  The health care system in America is certainly imperfect and riddled with problems.  While insurance coverage for mental health treatment has improved, particularly by the passage of the Affordable Care Act which has given access to millions of Americans, the system is flawed.  As a mental health care provider, I’m grateful to KQED for reporting on this issue.  I hope that this contribution may help spawn greater awareness and dialogue which results in better conditions for providers and consumers alike.

Comments are closed.