Please read this post on KevinMd.com entitled How Managed Care Caused Mental Health Care Crisis.
Here are a few points the author, Dr. Northrop makes:
[M]ental health benefits are now commonly “managed,” such that patients may be restricted to doctors in the insurance company’s network, and doctors who want to be in the network must accept drastically-reduced fees. Anti-trust laws prohibit health care providers in private practice from organizing to negotiate more equitable fees, so the drastically lower rates are “take it or leave it.”…
…A psychologist working with managed care today receives a total fee about equal to what [the author] charged in 1987. Adjusted for inflation, per session fees have declined 47% over that period of time….
…Mental health has proved especially vulnerable to the ravages of managed care because its patients tend not to be assertive about their right to treatment and because the subjective nature of emotional distress makes it easier to deny or restrict, by way of pre-approvals and treatment reviews, than many medical conditions whose symptoms can be documented with blood tests or x-rays….
…Prospective patients have more trouble finding therapists with time to see them or who will accept fees that barely cover taxes and operating costs.
I whole heartedly agree with this post by Dr. Northrop. Unfortunately, our current system is set up to deny mental health treatment. Those most in need have a hard time finding providers and often can’t afford them – even if they have insurance. Many mental health providers have left the managed care system (and rightly so). The administrative burden coupled with the low reimbursements provide a disincentive for providers to accept any insurance plan. And as stated above, anti-trust laws don’t allow these providers to come together and demand higher reimbursement rates.
This only hurts the patients who can’t find help and end up in hospitals or dead. Patients who are already suffering from serious illnesses have no where to go in a system like this. A system that is likely to get worse under the new Accountable Care Organizations to be developed.
As a community we need to advocate for higher payments for these providers. And for patients, we need to find ways to get them care.
If a patient has insurance but cannot find a provider on their plan that is accepting patients or treats their specific illness, there is the ability to ask the insurance company for a special exception (or in-network exception – this may have a different term depending on the insurance provider). Insurance plans must include enough providers in their network to cover their insureds. For instance, a plan must have a hospital in the network, oncologists, radiologists, etc. and they must contract with enough of them for all the people on the plan (this is called network adequacy). If they do not have enough or a certain provider, they have to allow the insured to see a provider outside their network and pay reasonable billed charges (not just the charges they are willing to pay). Simply ask “I would like to request an in-network exception based on the fact that there are no contracted providers where I live who treat or are willing to accept patients with [mental illness]”
Of course, you still have to prove that the treatment is necessary and you may have to follow up with the insurance company to make sure they are giving the right reimbursement. Be your own advocate as best you can, keep asking to talk to managers and supervisors about your coverage if you are told no at lower levels. This is one little secret they don’t want you to know and don’t want you to use.
We cannot let conglomerate insurance companies (reporting their 3rd year of record profits) deny our right to mental health.