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2022 HEALTH CARE EDITION
o ce sta , many forgo dealing with insurance claims altogether. “At the time of the survey, 21% of providers said more than 75% of their business is self-pay,” said Kath- erine Novak, a public a airs specialist with the APA. In a survey of most recent Psychology Today listings—an industry publication that also bills its website as “the world’s largest portal to psychother- apy”—about half of the licensed professional coun- selors in the San Marcos 78666 ZIP code accept one or more forms of insurance, but that number drops to 25% or less when counting psychiatrists. Even those larger practices that try to o er a vari- ety of insurance options nd the process daunting. “Getting my Ph.D. was easier than getting us cre- dentialed with Medicaid,” said Dr. Anne Esquivel, president and founder of Mind Works Clinical and Counseling Psychology practice in New Braunfels. Esquivel said her practice hired several new ther- apists who are unable to see patients because they are waiting for approval from insurance companies. “They are not here seeing patients and helping kids and families because to get them credentialed by the di erent insurance panels—Blue Cross, Tri- care, Cigna—all of those big players, is months.” Need outpacing availability According to Mental Health America, a national nonpro t that studies mental health care access and trends in illnesses, Texas ranks 51st in the United States in access to mental health services for adults and 37th in the number of children with private insur- ance that did not cover mental health in 2020. Mental Health America’s access to mental health rankings showed that in 2020, 57.2% of adults with a mental illness in the United States received no treat- ment, or more than 26 million individuals. Of those, 1.96 million resided in Texas. A lack of access to providers can translate into fewer accepting insurance at all. Because of the need, they can fully book their openings with patients willing to pay out of pocket. Dr. Jon Lasser, a professor of school psychology at Texas State University, runs a private clinic a few hours a week focused on children and adolescents. In his case, it does not make sense for him to hire a billing specialist, and most of his clientele are will- ing to pay out of pocket. “I think that other people have also found that the insurance coverage isn’t very good. They may say, ‘Well, my coverage is only for eight sessions.’ And that doesn’t make sense for most people to think that you can sort of take care of any major concerns in just eight sessions,” he said. Lasser said that reimbursement is often half the going rate. “But there is an acknowledgment that a lot of people expect their insurance company to cover them, and they wonder, ‘Why can’t I nd a therapist that takes insurance?’” he said. “So we see it from both angles, and there’s kind of a tension around that.” In some cases, insurance companies might limit the number of providers they work with in the network. “We played around with trying to get onto [health insurance company] Cigna. We didn’t get in because
Factors in not accepting insurance One reason therapists increasingly decline accepting insurance is because they can book a full schedule of clients who can pay out of pocket and/or are willing to submit insurance claims themselves.
Texas ranks 51st (in rankings that include the District of Colombia) in access to mental health services for adults, according to Mental Health America.
Out of 4.7 million adults with any mental illness (AMI) in the US, 644,000 reside in Texas .
13.7%
Individuals seeking treatment but still not receiving needed services face the same barriers that contribute to the number of individuals not receiving treatment:
22.3%
Insu cient nances to cover costs—including copays, uncovered treatment types or when providers do not take insurance Texas ranks in lack of access to care with 4th 19.2% of adults with AMI reported unmet treatment needs.
No insurance or limited coverage of services Shortfall in psychiatrists, and an overall undersized mental health workforce Lack of available treatment types (inpatient treatment, individual therapy, intensive community services) Disconnect between primary care systems and behavioral health systems
of all adults nationally with a mental illness reported they were not able to receive the treatment they needed . This number has not declined since 2011.
Securing reimbursement
When a patient must submit an insurance claim for mental health care, the process can be daunting. These tips can help people through the process. Ask the provider to create a bill for service Call insurance provider for how to submit If rejected, submit appeal to insurance provider Complaint can also be led with the Texas Department of insurance For Medicaid or Medicare rejections, Centers for Medicare & Medicaid Services can enforce appeals
Mental health workforce availability is a ratio showing the rate of mental health providers in every state. The District of Columbia is included as a separate entity.
of providers Availability
Top 5
Bottom 5
1
47
Massachusetts: 180:1 Oregon: 210:1
Arizona: 790:1 Georgia: 790:1
2
48
3
50 51 49
Maine: 220:1 Vermont: 230:1 District of Columbia: 220:1
West Virginia: 830:1
Texas: 960:1 Alabama: 1,100:1
4 5
SOURCES: AMERICAN PSYCHOLOGICAL ASSOCIATION, MENTAL HEALTH AMERICA, NATIONAL ALLIANCE ON MENTAL ILLNESS, TEXAS DEPARTMENT OF INSURANCE COMMUNITY IMPACT NEWSPAPER
Seeking reimbursement Health insurance companies o er the ability to submit claims in various ways to get some of those out-of-pocket expenses covered, though the process does not guarantee partial or any reimbursement. For providers that do not accept insurance, the provider can create a bill for the patient to submit. The Texas Department of Insurance o ers guidelines for if a claim is denied. “One model is to work with families and say, “OK, I’ll give you a receipt, and you can send it to your insurance company,’” Lasser said. “They may reim- burse you, and some families have plans that will do that, other not and it’s kind of hit or miss, it seems.”
rates were so low, we would lose money soon,” Esquivel said. Esquivel added that rather than nego- tiating rates, the insurer declined to add her practice. “They limit the amount of providers they will allow into the network or into a speci c ZIP code,” she said. While mental health care providers make do with helping as many patients as they can, the demand for more providers will keep those currently in practice busy as ever. According to the Mental Health America survey, there is a signi cant mal- distribution of mental health professionals, espe- cially in rural areas. Their report cites that in 2016 more than half of all U.S. counties did not have a single practicing psychi- atrist, for instance. Where a state like Massachusetts has one mental health provider for every 180 people, on the other end of the spectrum, Alabama has one for every 1,100. Texas has one for every 960 people.
For more information, visit communityimpact.com .
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SAN MARCOS BUDA KYLE EDITION • JUNE 2022
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