Insurance coverage of mental health care has limits – Press Enterprise

Insurance coverage of mental health care has limits – Press Enterprise

I stopped taking health insurance 25 years ago. I wasn’t pleased or happy to make this decision. Men and women work hard for their medical benefits, so of course they want to go to a provider who takes their insurance.

The difference between going to a provider in their network or paying out of pocket for a clinician who is not contracted can be substantial. Some health insurances, if their client goes to an “in network” provider has the patient responsible for only the co-pay which is often anywhere from $10 to $45. If the patient sees an “out of network” provider (like me) they have to pay the entire fee.

A session for a licensed family therapist or psychologist can be anywhere from $85 to $200. Psychiatrists charge, for an initial visit, close to $300.

Patients sometimes get angry when I tell them I don’t take health insurance. It is their perspective that I am some kind of elitist person who wants to overcharge. The reality is health insurance companies “manage” their care which can mean they have to approve, in advance, either every session or every few sessions.

This isn’t unreasonable for a clinician to have to establish a medical necessity for the visit. What isn’t said is the criteria for mental health medical necessity can be so subjective that some insurance companies can get away with saying they reviewed the request and determined it was not medically necessary when, in fact, the patient is still very depressed or anxious. It got to the point I was spending more time with reviewers than doing therapy. It was especially uncomfortable when the person declining my request for additional sessions was not even a licensed therapist.

The best explanation of the labyrinth trying to get mental health sessions approved aired on the Nov. 10 episode of Hasan Minhaj’s Netflix show, “Patriot Act.” Minhaj is a comedian and — fair warning — uses a lot of four-letter words. His comedy isn’t for everyone so if cursing offends you, you’re probably better off not watching. If, however, you want to understand why more and more mental health providers are no longer taking insurance, watch this episode.

Minhaj explains in detail, using actual families, what I have been trying to explain to those who call me and ask why I don’t take insurance. He details that although mental health benefits, by law, are supposed to have parity with physical ailments, they don’t even come close. There was a parity law that stated there shall be no difference in the benefits to treat mental health vs. physical illnesses. Even with this parity, because so much of mental health is not revealed in an X-Ray or MRI, the ability of insurance companies to refuse treatment has skyrocketed.

There are many people looking for mental health providers who find the clinicians listed on their insurance websites no longer take insurance, yet their names remain. My name has remained on panels I resigned from 20-plus years ago.

So, when prospective patients call me and say, “I see your name right here on the insurance list of approved providers. I know they are telling the truth.” The truth they don’t hear are these lists too often are out of date and include clinicians who have moved, no longer take insurance or in some cases have died.

Mitchell Rosen is a licensed therapist with practices in Corona and Temecula.

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