{"id":140106,"date":"2025-01-23T11:29:00","date_gmt":"2025-01-23T15:29:00","guid":{"rendered":"https:\/\/www.shortform.com\/blog\/?p=140106"},"modified":"2025-01-23T13:30:57","modified_gmt":"2025-01-23T17:30:57","slug":"health-insurance-crisis","status":"publish","type":"post","link":"https:\/\/www.shortform.com\/blog\/health-insurance-crisis\/","title":{"rendered":"How the Health Insurance Crisis Impacts Mental Health Services"},"content":{"rendered":"\n

What’s driving providers out of insurance networks? What does this mean for people seeking mental health treatment?<\/p>\n\n\n\n

In the United States, getting therapy is more difficult than ever. Due to problems with insurance companies, a third of US psychologists no longer accept insurance. Reasons include low reimbursement rates, complex payment systems designed to delay or deny payment, and pressure to limit care. <\/p>\n\n\n\n

Continue reading for a deep dive into the current health insurance crisis<\/a> in the US.<\/p>\n\n\n\n\n\n\n\n

The US Health Insurance Crisis<\/h2>\n\n\n\n

The insurance crisis is creating a growing gap between people needing mental health care<\/a> and available providers, according to an American Psychological Association practitioner survey. People seeking mental health treatment are <\/strong>10 times more likely<\/a> than those seeking other medical care to encounter providers who don\u2019t accept their insurance, forcing them to either pay out of pocket or go without treatment.<\/p>\n\n\n\n

The financial impact is substantial. Mental health sessions typically cost $100-$200 per visit<\/a> for patients who must pay directly. Insurance coverage type also affects access to care: While 58% of psychologists accept private insurance plans, far fewer work with government programs, with only 36% accepting traditional Medicare and just 26% participating in Medicare Advantage plans.<\/p>\n\n\n\n

Profits Over Care<\/h3>\n\n\n\n

The gap between mental health needs and available providers reflects a fundamental conflict between patient care and insurance company profits<\/strong>. The 2008 Mental Health Parity and Addiction Equity Act<\/a> required insurers to provide mental health coverage equal to physical health coverage. However, more than a decade later, the law has failed to ensure adequate access to care,<\/strong> as insurance networks still lack enough mental health providers to serve patients seeking care.\u00a0<\/p>\n\n\n\n

A 2024 ProPublica investigation<\/a> suggests this shortage of providers is by design, revealing that insurance companies deliberately maintain inadequate mental health networks because they view patients needing ongoing mental health care as unprofitable<\/strong>.<\/p>\n\n\n\n

How Hospital Reimbursement Works
<\/strong>
Another example of the state of US health insurance can be seen with hospital reimbursements, as explained in An American Sickness<\/a><\/em> by Elisabeth Rosenthal. Hospitals provide the medical service to the patient, then are reimbursed by the payers (insurers) for the service. This practice has led to a complicated set of billing practices and gamesmanship to maximize hospital earnings. Hospitals employ reimbursement consultants to adjust their prices and billing practices to earn more money.

The high sticker price given by hospitals is a negotiating point with payers (insurers). Bigger payers pay a smaller fraction of the list price than smaller payers and the uninsured.

Medicare assigns to every hospital an overall cost-to-charge ratio it considers reasonable. This is meant to constrain the profit percentage that hospitals can make. However, this regulation turned billing into a strategic game. For example, hospitals adjusted their prices to maximize billing. They lowered charges for items that are often not reimbursed (like gauze) and boosted charges for what is reimbursed (OR time, oxygen therapy).

This led to a perplexing practice where a single procedure, like an overnight stay in the hospital, can be billed separately as a wide array of items. This is why a hospital bill can include dozens of charges, including individual Tylenol pills and charges for each separate doctor\u2019s time.

Billing is done aggressively, to the limit of what is acceptable for the service provided. This is called \u201cupcoding.\u201d For example, a simple blood draw can be classified as a level 5 doctor visit. Optional services can be added to increase billing, without necessary patient benefit\u2014using ultrasound to inject steroids in a knee adds $300. <\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n

Obstacles for Providers<\/strong><\/h3>\n\n\n\n

Insurance companies\u2019 practices create multiple obstacles that are driving mental health providers out of their networks:<\/p>\n\n\n\n