Insurance companies are actively creating barriers to mental health, and the Florida State Insurance Commission is turning a blind eye.
The majority of licensed mental health workers are either in small group practices or individual private practices. In 2018, two of the largest insurance providers reduced their reimbursement rates by over 30%, while therapists’ costs to stay in business continue to escalate.
Specifically, Tricare, the provider of insurance to our active duty and retired military families, recently awarded its contract to Humana. Since Jan. 1, 2018, Humana has taken several steps which limit access to care. They issued new contracts to providers which drastically reduced reimbursement. Many providers did not renew their contracts because of the cuts. Fewer providers means fewer choices for new patients. Patients seeing therapists who opted out of the contract are now forced to find one of the few remaining therapists who still accepts their insurance and is accepting new patients, or to self-pay for services when they have insurance coverage.
Florida Blue, which is locally managed by New Directions Behavioral Health, was the other large network that cut reimbursement rates in 2018. Currently, this managing entity is wait-listing new provider applications to be in network because “If there is need in your area in the future, we will contact you.”
These are important oversights, since:
· Mental health conditions are common among teens and young adults. One in five live with a mental health condition; half of all chronic mental illness begins by age 14; three-quarters by age 24, according to the General Archives’ “Prevalence, Severity and Comorbidity of 12-Month DSM-IV Disorders in the National Comorbidity Survey Replication.”
· Over one-third (37%) of students with a mental health condition age 14-21 and older who are served by special education drop out – the highest dropout rate of any disability group, according to the U.S. Department of Education’s 35th Annual Report to Congress on the Implementation of the Individuals with Disabilities Education Act.
· Suicide is the 10th leading cause of death in the U.S., and the second leading cause of death for people aged 10-34, according the to the National Institutes of Mental Health’s “Suicide” report.
The above statistics should be enough to demonstrate a need. Any parent or guardian that has attempted to connect their child or adolescent to counseling services in Clay County will tell you it is extremely difficult, with limited options, and long waits. The same challenges are present for adults seeking services, but it is more severe for youth. The health insurance industry procedures, policies and inefficiencies are at the root of the problem.
There are few careers where demand is high, public accountability is high, but compensation continues to decline, and at an accelerated rate. Reimbursement rates have now been reduced to where they were 40 years ago. The choices presented to mental health professionals are to continue to work for significantly less or to stop accepting insurance and try to build a self-pay practice. Even with insurance network approval, the barriers to payment create another obstacle to stay in business.
If access to mental health is so important, why are insurance companies allowed to make decisions that drastically reduce access to care? Any person with health insurance struggling to find a mental health provider should contact the member services phone number on their insurance card and express concern over the limited options in their area.
Jenny Sandell, LMHC
Full Circle Counseling Services, LLC