Three major problems with health insurance for mental health patients right now

1.18.18

Patients seeking care for their mental health face unique hurdles ensuring their treatment is covered by their insurance plan. While parity laws – which are meant to protect patients by preventing health insurance companies that provide specific mental health benefits from “imposing less favorable benefit limitations on those benefits than medical/surgical benefits” –  have been passed by Congress to combat insurance companies attempts to limit benefits for mental health patients, discriminatory insurance policies continue to harm these patients.  The Chronic Disease Coalition looks at three major problems with health insurance that mental health patients still face:

1) Mental health providers are less likely to accept insurance. According to this recent article by Marketplace by APM, there’s a lack of insurance companies that have taken the initiative to bring mental health providers into their network. A study published in the Journal of American Medical Association (JAMA), only 55 percent of psychiatrists even accept insurance. JAMA noted that in comparison with all health care professionals, “Acceptance rates for all types of insurance were significantly lower for psychiatrists than for physicians in other specialties. These low rates of acceptance may pose a barrier to access to mental health services.

2) Even when a mental health professional is in an insurance network, they tend to receive lower rates of reimbursement compared with other medical professionals. Another recent study conducted by Milliman analyzed disparities in network use and provider reimbursement rates. They found that even when a mental health professional is in an insurance network, mental health professionals receive a “significantly lower insurance company reimbursements” compared with other medical professionals. In fact, in August 2017, Blue Cross and Blue Shield of Minnesota announced in August that it would be decreasing mental health reimbursements.

Speaking to the Star Tribune, Minnesota’s largest newspaper, Sue Abderholden, executive director of the National Alliance on Mental Illness-Minnesota recently explained “If [insurance companies] are paying a whole lot less [to mental health professionals] that is a parity violation,” “One of the reasons that there is going to be more out-of-network care is because a lot of psychiatrists do not take insurance and now we see why.”

3) Insurers may force patients to subscribe to “fail first” methods before being prescribed the most effective medication. Additionally, insurers can decide whether a patient requires a certain treatment and at what frequency. Providing equitable and effective treatment to mental health patients can be tricky, as psychiatrists and other mental health professionals need to treat the person, not the disease.

In an interview on WGNS Radio, Jeff Fladen, the executive director of the National Alliance on Mental Illness-Tennessee said: “We are hearing stories from consumers across Tennessee who are stable on a medication for years and then are suddenly forced off. With mental illness, treatment often looks more like an art than a science as the treatment provider tries various medications. It can take years to find the correct medications that enable an individual to keep symptoms at bay.”

The Chronic Disease Coalition continues to work with other advocacy organizations across the country to ensure that chronic patients have access to the treatment they need to control their disease