Why You Struggle to Find a Therapist
The shady practices of health insurance companies and the Biden-Harris Administration's new regulations to help
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If you’ve struggled to find an in-network therapist recently or learned that your therapist is leaving your network, you’re not alone. Over recent years, health insurance companies' harassment of clinicians has driven countless therapists to leave insurance networks. Pretty much any clinician who is left in-network is barely hanging on.
Each day, my local therapist listserve peppers my inbox with workshop announcements, client referrals, and, more and more, exasperated requests about how to handle a threatening or mystifying letter from an insurance company. Whether they’re demanding compliance with a new rule, delaying payment, or denying claims altogether, these letters and phone calls pile up. Therapists are seeking support and information from one another, but we’re buckling under the weight.
Therapists are not unionized. Most of us work in private or small group practices. There are just not enough deep breaths or hours in the day to manage it all on our own.
Despite the Obama-era law requiring parity of coverage between mental and physical healthcare, insurance companies have been ramping up their methods to dodge, ignore, deny, or delay mental health coverage. Like skilled tax evasion, they have countless tactics to save themselves money and, ultimately, demoralize therapists enough to drive us out of network. This is consistent with their goal. When there aren’t enough therapists in-network to cover their insured, they pay fewer claims and can quietly pass the blame to a supposed shortage of therapists for which they have no responsibility. This adds to the pervasive false narrative that therapy is a privilege rather than healthcare, which further keeps people from seeking the help they need.
Therapy is not a privilege. Nor is it an inherently scarce resource. In a capitalist, white supremacist, patriarchal culture, mental health is painted with the same brush that deems anything good for us as indulgent. But mental and physical healthcare is part of any sane, healthy society, like food, housing, clean water, access to nature, freedom from violence, and connection with others. Today, in America, mental healthcare is out of reach for most people because of a fractured healthcare system and persistent, shady corporate practices that are against federal law.
At a time when we should be radically expanding access to mental health care and treatment for psychological trauma and substance use disorders, access has been shrinking.
A recent ProPublica article, "Why I Left the Network," highlights the often mundane yet enraging ways that insurance companies wear down therapists, leading to significantly diminished availability in-network and sometimes life-threatening premature termination of care. Therapists are forced to choose between making an income or martyring themselves on the altar of modern American healthcare to protect their patients over and over again. Every one of us has stories.
So, I am celebrating news that the Biden-Harris administration has passed new regulations to address the mounting threats to mental health coverage and, therefore, mental healthcare in America. Their official statement beautifully summarizes the need these regulations seek to fix.
In 2020, less than half of all adults with mental illness received treatment. For children, the numbers are even worse: nearly 70 percent of our kids who seek care for mental health or substance use cannot get it. That’s in part because insurers too often make it difficult to access mental health treatment, causing millions of consumers to have high out-of-pocket costs because they go out-of-network, or defer care altogether.
One study shows that insured people are nearly four times as likely go out-of-network and pay higher fees for mental health care than for physical health care. And the problem is getting worse: in recent years, the gap between usage of out-of-network care for mental health and substance use disorder benefits versus physical health benefits increased 85 percent.
The new federal regulations address various loopholes that have allowed insurance companies to duck compliance and deny people coverage.
I’m grateful for these regulatory steps and the uptick in reporting on the issue from ProPublica and NPR. I hope that broader awareness about what is happening behind the scenes for therapists will lead to an improvement in mental health coverage for all of us.
If you’ve been looking for a therapist who takes your insurance, please don’t give up.
Read the official Biden-Harris statement to learn more about what these regulations will do and the ProPublica article for a clear breakdown.
And make a plan to vote. If you’ll be out of state at college or graduate school, request an absentee ballot ASAP or register in your new state.
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I’m Satya Doyle Byock, psychotherapist, author of Quarterlife: The Search for Self in Early Adulthood, director of The Salome Institute of Jungian Studies, and co-host of a podcast on Carl Jung’s Red Book. My work has been featured in The New York Times, The Guardian, Oprah Daily, NPR, The BBC, Literary Hub, The Tamron Hall Show, and on podcasts such as Apple News in Conversation and The Joseph Campbell Foundation Podcast. Find links here.
I have been a licensed practitioner for almost almost 30 years and remember 1994 when HMOs were just beginning their entrance into the therapeutic arena. Since then, therapists have been regulated and restricted from earning a reasonable income and the privacy and general mental health of their patients have been regulated to the detriment of clients' health and the disrespect of therapists devaluing their discretion, confidentiality and imposing exploitive monetary restrictions. UHC/UBH/Optum for instance refused to increase reimbursement for almost 20 years from $60 per session. I negotiated with them for 18 months before finally receiving an increase to $90 and eventually $115. They have done in person audits of records and office in my time. Magellan's practices imposed restrictions by constant regular reviews and if the client was not suicidal they imposed limits on sessions. Their interference crossed confidentiality boundaries and I left the network 6 years ago. This is not a new problem but it is worsening as now "claw backs" for sessions are more common and new regulations such as the "no surprise act" requiring therapists to predict a timeline to ascertain total cost of therapy is required regardless of diagnosis. Our membership organizations have not been able to help navigate these issues, provide a Union organization or work towards wage increases. I can cite numerous issues that have arisen over these many years, but the bottom line is that health care for profit serves only the health care corporations and harms both clients and therapists. I am appreciative that these issues are being brought to light at last.
Thank you for elaborating on this topic. Wouldn’t it be great if as consumers of insurance policies there would be a way to apply pressure on them ? It is criminal what they are doing to squeeze out therapists and people that require care.