As part of the interview for my book, I asked about the role that mental health plays in healthcare. Responses were unequivocal: It plays a vital role. All of these doctors have patients who are depressed, anxious, traumatized, or otherwise in need of mental health services. My doctor interviewees frequently added comments about lack of access to mental health services and insurance interference.
Refusal to pay is a big problem, according to my doctor interviewees. One doctor said, “You can’t get an appointment with a psychiatrist. I try and make referrals. Insurance won’t cover it, you can’t find someone to see, and there is a stigma.” Another one said, “It’s hard to find good therapists, and no one is in-network.” (Recent news is that only about 11 percent of all psychotherapists are in-network.) Another agreed, “Drugs have limited value. Therapy is of value. But it is an unreimbursable commodity as insurance does not cover it.”
It’s a lot to manage in medical practice. One doctor explained, “We don’t have the resources in the practices to handle it. We have generalists who don’t have the training. To manage the amount of bipolar, ADD, ADHD, OCD, PDD, depression and you can’t get the insurance to pay.” Another one said, “It’s another area of great need and broken-ness. It is hard to find good care. Reimbursements are low. Licensing and preparation to reach to that point where you are qualified is a very difficult task. So we rely on church, family, counseling.” Another doctor said, ” How do you do this with 9 minutes allowed per visit?”
Prior to writing my book, I participated in two data-based research projects, which were published, with the New Jersey Psychological Association, investigating insurance and mental health care. In the first project, psychologists reported, among other findings, pressure to change quality of care and compromise ethics based on patient protection. A “treatment concern cluster emerged,” which included the items, being unable to get on the panel, having to go through lengthy precertification, having to fulfill lengthy screening requirements, being forced to discharge before the patient is clinically ready, having untrained personnel making patient care decisions, dealing with slow response from the company to requests for approval of sessions, having a clinically inadequate number of sessions and dealing with increased paperwork.
A decade after the first project, I co-authored another article with the New Jersey Psychological Association, based on data collected in an Insurance Complaint Registry, which documents insurance abuses in denying mental health care. Complaints were collected from psychologists and summarized into general categories: denying coverage for treatment, difficulties with treatment authorization, miscellaneous actions resulting in negative impact on patient, network issues, insurance company provided misinformation or was unresponsive to inquiries, and payment difficulties due to insurance company errors. The list of actual items in each category is in the article. Some of them are just absurd. As the saying goes, “You can’t make this stuff up.”
These three data sets, two reporting responses by psychologists and one reporting responses by physicians, reveal a consistent and clear picture of significant barriers to mental health care in our state. Inadequate mental health services drives up medical care costs and decreases workplace productivity, as unequivocally documented by research. What is the point of having mental health parity laws, where mental health care benefits are comparable with medical health care benefits, if the insurance companies deny and refuse to honor existing coverage? The insurance companies need to be reined in and forced to honor mental health coverage. Our well-being depends on it.
Peggy A. Rothbaum is a psychologist and can be reached at her self-titled site, Dr. Peggy Rothbaum. She is the author of I Have Been Talking with Your Doctor: Fifty doctors talk about the healthcare crisis and the doctor-patient relationship.
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