Access Issues to Mental Health: Part 3
In 2011, 62.3% of Californians who needed mental health treatment did not receive this service (see link to data below). While insurance companies are required to provide mental health benefits, access to these benefits can range widely. Cost is a major barrier to access, even with the help of insurance benefits. Clients with spouses and/or families on their plan are often burdened with high deductibles before they can access benefits. This means that clients often have to pay out of pocket for services for months until their deductible is met and their benefits are in effect. Some deductibles are so high that it won’t be met until the last month of the year, if at all. The trend tends to be that when the monthly payments for insurance is lower, the higher the deductible rate. For individual policy holders, employer sponsored plans and university sponsored plans often have reduced deductibles to $0 deductible. More on insurance benefits in Part 4: Understanding Insurance Jargon.
Tips on managing costs for mental health services:
- Before subscribing to an insurance plan, make sure you:
- Understand the benefits (See Part 4)
- Find at least 3 providers who are accepting new clients within this network
- Estimate the medical costs and mental health costs and choose the plan that best fits your need
- Budget and prioritize your expenses for the month/year
- Access employer sponsored EAP services: usually 3-8 free sessions per year
- Be prepared to pay full fee for services if you see an Out of Network therapist
- Ask your employer if they have Health Spending Account/Flexible Spending Account options. This money is taken out pre-taxed and can be used towards mental health services.
- Reduce chances of missed appointments or late payments with reminders
- Ask your employer about options to make up missed work without loss of pay
- Remember that not all quoted benefits by insurance reps are guaranteed payment, so plan for possible extra expenses.
When a therapist accepts insurance, they are providing services at 30-50% of their regular fee with required additional administrative tasks. Because of the managed care requirement, therapists often cannot see more than a set number of insurance clients per week. To do so may reduce quality of care. In addition, the standard of care is sometimes reduced to what insurance deems medically necessary rather than what the provider recommends. Additionally, most insurance plans do not cover relational issues, such as couples work. When they do cover couples, one person often must be identified as having the mental health issue to which couples therapy will help resolve. Thus, providers often opt out of working with insurance due to theses limitations. It is important to acknowledge that the medical model for mental health can be successful with certain populations, but it does not fit with all mental health issues.
The financial burden both for therapists who accept insurance and clients who need to use their insurance is a real issue that continues to go unresolved. What is clear is that more and more people are seeking therapy, thus demand continue to rise and supply continues to dwindle. It would be interesting to see where California legislation will change as talks of a single payer system is currently in the works. For more reading and data on this matter, see links below.
http://www.mentalhealthamerica.net/issues/mental-health-america-access-care-data
Thien Pham, LMFT 