Psychiatrists and Health Insurance

Posted on: Wednesday, January 8, 2014

Mental illness and its treatment unfortunately still carry a stigma in many quarters of our society. With so much news focusing on calls for better observation and treatment of mental disorders, it may have surprised many when a recent study revealed that barely 50% of all office-based psychiatrists accepted any form of health insurance compared with physicians in other specialized fields. On December 10, Vice President Joe Biden announced new initiatives to increase access to mental health services with $100 million in government funding. Still, many observers wonder why this problem is so prevalent.

The study doesn’t formulate reasons for the existence of this situation, nor does it cover clinic or hospital psychiatrists. It could be that insurance doesn't pay psychiatrists enough for the time they spend with their patients, as compared with a health network’s PCP, for example. The findings may also reflect a shortage of registered, private psychiatrists, forcing more patients to fully pay for their psychiatric services. There may, however, be a more disturbing reason. The healthcare industry, as it is structured, may be to blame.

Many modern treatment decisions are influenced by guidelines which insurance reviewers are obliged to follow. Mental health care is often singled out, subject to coverage limits that are a fraction of the coverage provided for other illnesses.  Referrals for psychiatric evaluation or psychotherapy often require the approval of third parties disengaged from the day to day practice of clinical medicine. Most significantly, this process may require details regarding a patient’s psychiatric history as a condition of payment. For many psychiatrists, this is tantamount to the sacred breach of private and confidential relationship between doctor and patient.

Any insurance submission leaves a trail of information through several layers of a health network. Since mental illness can be so misunderstood, and so polarizing, patients and doctors prefer to avoid exposing this material to anyone with access to it. This suggests that patients with a serious need for mental health care may never receive it until controls are implemented that would protect the confidentiality of the patient’s records. The rules of healthcare networking would have to change.

In 2011, the Substance Abuse and Mental Health Services Administration (SAMHSA) revealed that half of all Americans can't afford mental health care. Unlike more traditional medical problems, mental health care treatment often requires years of ongoing therapy and outpatient care. Obviously, this makes many of the neediest patients less likely to purse essential care. For children, the problem is even worse, because research shows that 70 percent of children in need of mental care do not receive it.

How do these problems resolve themselves? Can they be resolved? Obviously, there are no easy answers, but insurance agencies like Core Benefits Group are poised to be part of the solution, and not part of the problem.

Got questions about your health coverage? Core Benefits Group would like to help. Please call us at 1-877-214-2969.


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