It’s not always easy to navigate what your health insurance covers when it comes to mental health — but it can make a difference in determining whether or not employees receive quality treatment, if any care at all.
The U.S. is witnessing an eruption of demand for
However, 45% of Americans with clinical-level mental problems have
Employers can play a major role in ensuring that employees are getting the help they need by offering options that provide a spectrum of care, and communicating those offerings to employees, says India Gomez, a clinical psychologist with an independent practice in the San Francisco Bay Area. She spoke with Employee Benefit News about the
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What is the biggest barrier your clients face when accessing your care?
I think that one of the biggest barriers is actually a financial barrier. First of all, you have to have healthcare insurance. Then, if you're dependent on your health insurance to find a mental healthcare provider, you may run into more difficulties. You have to think about which providers are in the insurance company’s network. Do these providers have the specialty most appropriate for what someone is going through? Are these providers a good cultural match?
I have clients who have various plans through their employers. I know some are HMO [Health Maintenance Organization] plans, which means you have to see providers who are in-network. If you see someone out-of-network, you receive no reimbursement for the medical care. This forces clients who are culturally diverse or neurodivergent to potentially see therapists who may not be a good fit for them. At least by offering PPO [Preferred Provider Organization] plans, employees would be able to seek providers out-of-network.
What should employers watch for when choosing plans?
I recommend they choose insurance companies that provide unlimited mental healthcare, which allows clients to determine the length of the session and treatment rather than insurance companies dictating it. Some insurance companies will only cover what is considered in my field to be shorter sessions — be mindful about making sure that insurance companies will cover a 53-plus-minute session.
Another consideration would be continuity of care. If an employer is not making a long-term commitment to a particular insurance company, make sure that continuity of care benefits exist. So, if you're changing insurance, a client could easily get a single case agreement with a new company, even if their therapist is not in-network with that company.
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Without continuity of care, what happens to the employee?
A lot of clients have already gone through tremendous difficulty trying to find their previous provider. Every time a company makes an insurance change, if a client does not have a continuity of care plan, they may have to call dozens of therapists. It could potentially take them months. Once they find one, the provider might not be a good fit. If you think about other medical problems, we would say that it’s unacceptable for someone who has heart disease or cancer to wait months before finding a new provider.
Three of my clients had unexpected insurance changes through work. I negotiated one single case agreement, which was probably the biggest nightmare in terms of getting paid and administrative time. Another client had no continuity of care benefits, so they started paying out of pocket. Another client decided not to continue therapy.
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When you consider the future of mental health care, what worries you most?
As part of telehealth expansion, you're going to see an increase in companies offering a low-cost under-reimbursement type of mental healthcare. [For example,] if the insurance company pays a one-third rate, mental healthcare providers will have to see three times as many clients to hit a living wage.
When companies are considering which insurance companies to choose, try to evaluate which companies offer better reimbursement for therapists. When mental healthcare providers are paired with insurance companies who pay at such a low rate, the quality of care will likely suffer since they have to see a much higher volume of clients than is healthy.
I am sure companies want to be cost-conscious, but just because you’re paying less doesn’t make it better mental healthcare for your employees. Ultimately, I would think that companies want their employees to be in good health because they're going to perform better and they're going to stay longer. So paying less for the insurance could end up costing them.
On the flip side, what are your hopes for the future of mental health care?
I’m hopeful that the reimbursement rate from insurance companies will be much more on par with how medical care is reimbursed. I also hope that we end up with a single-payer system. I don't know how close we are to that, but I think that would be a tremendous benefit to many folks.
