“Mental Health” is a big focus on everyone’s minds these days. After all, addressing our mental health is as important as treating any other general medical condition such as diabetes, asthma, or a broken leg. And with recent research suggesting that most people will be diagnosed with some form of mental disorder during their lifespan, it’s only reasonable that insurers provide appropriate coverage for such a common health issue. It’s talked about so much that it almost feels as if this chronic issue is getting close to some resolution. Yet the reality is far from it!
When my daughter started seeing a mental health professional, I assumed that her sessions would be adequately covered by my health insurance provider. But when I began receiving the bills for my daughter’s therapy sessions, I was floored. Not only was the co-pay for a single session over $300, but we were also then billed an additional $600 for subsequent sessions that weren’t covered at all by our insurance. Since my daughter’s treatment plan involves regular visits to two facilities, we were ultimately charged over $1000 per session for a combined total of 12 sessions at both facilities, with a total due of over $24,000!
While our family had the ability to help my daughter cover this astronomical financial responsibility, it’s not sustainable for us and I know that millions of other Americans in dire need of mental health care aren’t able to either. I had to wonder – how did we get here? Why is appropriate mental health coverage so unattainable in the U.S.?
One major barrier to coverage is the incredibly high standards that mental health patients must meet before many insurers will authorize treatment. When someone with a life-threatening general medical condition seeks treatment at their local emergency room, they usually are admitted immediately. But when it comes to admission for a psychiatric issue, the rules can become confusing and draconian. That’s because many major insurance carriers require a phone call requesting prior authorization before a psychiatric patient can be admitted, even if they are suicidal. And until authorization is granted, they are forced to remain in the waiting room instead of receiving potentially life-saving treatment. Unfortunately, there’s a decent chance they will be turned away when a doctor is finally able to get a response from the insurer – U.S. denials for mental healthcare occur twice as often as those for general medical healthcare.
Even when a mental health or substance abuse patient is lucky enough to obtain authorization for treatment at a psychiatric facility, insurers frequently cut off coverage before they have been declared healthy by their treating physicians. This heartless and arbitrary termination of care can sometimes result in tragedy. Earlier this year, a federal judge in Northern California determined that a subsidiary of United Healthcare Group, a major U.S. insurer, had consistently utilized policies that discriminated against mental health and substance abuse patients in an effort to cut costs. While the decision was hailed as a major victory by mental health advocates, it came too late for one of the plaintiffs in the case. Her son died shortly after leaving an inpatient substance abuse treatment facility against the advice of his doctors because his insurer had denied continuing coverage for his stay.
Patients that wish to undergo outpatient therapy sessions for common mental health issues such as depression and anxiety also face an uphill battle in accessing affordable coverage. This is because mental health professionals are reimbursed by insurance companies at a lower rate than general medical providers. The result is a disincentive for psychiatrists, psychologists, and therapists to accept private insurance since they know it will result in an administrative hassle and lower pay for their services. Recent data shows that only 55 percent of psychiatrists nationwide accept private insurance, compared to 89 percent of general healthcare professionals. And it’s mental health care patients who bear the brunt of this disparity when they search for an in-network provider in their area and quickly discover that their options are severely limited, if not non-existent. Many of them will choose to forego care entirely rather than pay the high out of pocket fees that are often required for a single session.
Worldwide, suicide claims a life every 40 seconds. The overall costs of mental health in terms of loss wages and decreased production output is estimated to be over 4 percent of the global gross domestic product (GDP), a figure that overshadows losses from cancer, cardiovascular illness, and respiratory disorders. By addressing mental health as the global crisis that it is, we can encourage a more open dialogue with patients and advocates. We must also fight for legislation that promotes a more comprehensive approach to mental health care, as opposed to current insurer policies that treat it as a separate issue from general medical coverage. By forcing insurers to address mental health with as much urgency as any other medical condition, we can make it harder for them to discriminate against mental health patients and institute insurmountable barriers to coverage.
First, we need to remove the stigma around mental illness and recognize it as a dire public health threat that demands action. And perhaps most importantly, we can support mental health patients in our own communities – by reaching out to a friend or family member struggling with anxiety, donating to a local cause that supports mental health, and volunteering our time to help an at-risk demographic for depression such as the homeless population and LGBTQ youth. By recognizing, understanding, and respecting those who suffer from mental illness, we can begin to improve the outlook for millions of mental health patients around the world.
My big question is awareness enough? Clearly, from my experience, it will take a lot of financial resources to solve this crisis and I hope for the sake of many individuals and families struggling with this crisis, the solutions arrive fast!
Mary Aggarwal, Founder and CEO/Circle4Parents