The Business of Mental Health II: Insurance as a Barrier to Care

In the previous post about mental health services, there was discussion about the provider's role in discussing billing procedures. In not being upfront about the financial aspect of the patient's care, mental health providers and/or their administrative staff can create an unintentional barrier to care.  First, a level of mistrust may develop because the provider omitted pertinent information that would allow the patient or parents to make an informed decision about whether the provider was a good fit for their needs and resources. More importantly, the actual billed cost may be too much of a burden for the family to carry long term; treatment may be stopped as a result despite its benefits. Similarly, the U.S. population's general lack of focus on mental health as a facet of overall health due to the stigma associated with it could potentially add to the decision to end care. 

The likely most important aspect of the business side of mental health involves insurance companies. Mental health providers absolutely need to be upfront about any costs associated with care. The seeking of psychological help, however, may first be precipitated by a discussion of insurance coverage and personal finances. Even if a provider is 100% honest about his or her costs, a lack of mental health coverage can be a huge barrier to getting much needed care. Co-pays for mental health services can also be too much for families to afford, especially given the current economic climate. Blue Cross, for example, may require as much as a $25 co-pay per visit. Imagine if you or your child needed to be seen once a week? Twelve hundred dollars annually can break the bank for many families. Additionally, insurance companies sometimes put financial limits on the mental health services that the subscriber can receive per year. This is especially true if a patient needs to be admitted to an inpatient psychiatric facility. Insurance companies decide how long they will pay for a patient to remain in a facility and, in some cases, will refuse to authorize inpatient days beyond a certain point. The specific reason is that insurances may deem additional inpatient days "not medically necessary" despite what the inpatient psychiatric team believes. Thus some may leave (or be discharged by their parents) from treatment too early for their specific needs in order to avoid the astronomical costs of inpatient psychiatric care. All of this results in patients who have been under-treated due to financial concerns, not an unwillingness to seek help.

Discussions of health care reform need to consider the subcategory of mental health coverage and what can be done in order to facilitate treatment for those who need it the most. This nation is only as (mentally) healthy as its sickest person.