The Mental Health Care Crisis:
Why Finding Therapists Who Accept Insurance Is So Challenging:
Therapy for Every Body is in network with Cigna and Aetna insurance, but it’s not always easy.
In an era where mental health awareness is at an all-time high, one might expect accessing therapy to be easier than ever. However, across the United States, patients seeking mental health care face a daunting challenge: finding therapists who accept their insurance. This issue stems from a complex web of systemic problems within the healthcare insurance system, creating barriers that affect both patients and providers alike.
Insurance companies play a pivotal role in shaping access to mental health care, often in ways that hinder rather than help. While federal laws mandate parity (more about parity at the end of this article) between mental and medical health coverage, several practices by insurance companies contribute to the scarcity of therapists who accept insurance. This crisis is exacerbated by broader systemic issues. Insurers wield an outsized influence in determining mental health care access and treatment, often prioritizing cost-saving measures over patient well-being. Meanwhile, there’s a glaring lack of effective oversight and enforcement of mental health parity laws. Antitrust laws further complicate matters by preventing therapists from collectively negotiating better terms with insurance companies.
The consequences of this broken system are far-reaching and potentially devastating. Patients with worsening mental health conditions due to interrupted or inadequate care may face severe personal and societal repercussions. The mental health care system, as it stands, fails to meet the needs of many who desperately require support.
For therapists who do choose to work within insurance networks, the financial limitations alone make it difficult to sustain a practice. Therapists have to contend with many challenges in order to provide in network care:
– Low Reimbursement Rates: Insurance companies often offer low and stagnant reimbursement rates, which fail to keep pace with the cost of living and running a practice. This can make it financially unsustainable for therapists to accept insurance. When I first joined Cigna’s network in 2018, they only paid $70 for CPT code 90837 (longer sessions). In 2023, my colleague joined their network, and they still start at $70. Inflation alone should have made it $85.
– Delayed Payments: Payments from insurance companies can be delayed for months or even years, creating financial instability for therapists and their practices. Once a claim is delayed, it can take hours and hours of follow up. There have been times when I called an insurance company, waited on hold for an hour, got transferred to a different department, waited on hold for another half an hour, then had to get transferred again, and then the call dropped.
– Unexpected “Clawbacks”: Even after services have been rendered and payments received, insurance companies may claw back payments unexpectedly, further complicating financial planning and stability. If they ask for records, and the progress notes don’t confirm medical necessity to their satisfaction, they can ask for their money back months or years later. This is usually the therapist’s liability, not the client who already received their services.
– High Administrative Burdens: The administrative overhead required to navigate insurance claims, respond to denials, and manage billing is significant, often taking time away from actual patient care. Whether our office admin does the billing or we hire a billing service, this is an additional charge on top of the low rates we are paid.
The cumulative effect of these issues is a mental health care system that often fails to meet the needs of those who depend on it. For individuals unable to access or maintain necessary treatment, the consequences can be severe, exacerbating existing mental health issues and contributing to broader public health challenges.
The path to reforming the mental health care system is long and complex, but it begins with recognizing the problem and supporting those working to solve it. By choosing providers who prioritize accessibility and patient care over financial gain, we can take steps towards a healthier, more equitable mental health care system for all.
At Therapy for Every Body, we recognize these systemic challenges and are committed to making mental health care accessible to all. Unlike many practices, we accept insurance because we believe that everyone, regardless of their financial situation, should have access to the care they need. We are proud to welcome clients of all ages and lifestyles, with immediate openings available both in person in the Bay Area and online throughout California only. Our commitment to inclusive and accessible care means that we stand by our clients, working within the system to ensure that they receive the support and treatment they deserve.
What does PARITY mean?
Mental health parity refers to the legal requirement that health insurance coverage for mental health and substance use disorder services be equal to (or on par with) coverage for physical health services. This means that insurance plans should not impose more restrictive limits, higher costs, or stricter rules on mental health and substance use disorder treatment than they do for other types of medical or surgical care.
Mental health parity is crucial for ensuring that individuals with mental health and substance use disorders have access to the care they need without facing additional financial or bureaucratic barriers. However, despite these laws, enforcement and compliance issues remain, with many individuals still encountering difficulties in obtaining equitable coverage for mental health care.
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