How You Can Make Mental Health Care More Accessible via Insurance Plans

Mental health care, for a lot of us, can mean the difference between thriving and just surviving. And even beyond the ongoing stigma surrounding the topic and lack of mainstream education, there are people who want help but simply can’t afford it. That’s where insurance plans come in.

But then there’s the issue of sustainability. With many insurance contracts, you’d need 40 or more clients in your caseload to even be able to accept their plans and maintain your practice.

Meanwhile, health insurance companies as a whole are making MORE money than Amazon (~30 billion dollars in profit for 1,031 U.S. providers in 2020 — AFTER they paid everyone).

And then you have the clawback fees: The insurance company decides a client you worked with doesn’t qualify for coverage, so they take the money straight out of your paycheck, leaving you in a state of financial collapse…THIS is what’s been happening in the mental health field.

So, let’s talk about it.

Who’s responsible for ensuring mental health care is accessible within in-network panels?

Quick answer: The owner of the insurance company. High-quality care for those insured is their responsibility — an appropriate level of coverage, reimbursement, and relevant services.

When a plan is lacking in one or more of these areas, then you could call it “phantom insurance.” Basically, it’s a plan you have but can’t actually use — it doesn’t have any real-world value. And, in those situations, you can contact a patient rights advocate to get the services you need.

Here’s where you step in and plan for your needs as a private practice owner.

Look at your current fees. Do you like where they’re at? If you’re happy with your current fees, consider whether accepting insurance works for you. That means that if you discover a plan isn’t going to align with your ability to have a sustainable business, it’s okay to say “no.”

Remember: You have to advocate for yourself. TAMFT or ACA or any other professional organization isn’t allowed to do it for you. So, when your business expenses and current fee don’t make sense if you accept an insurance plan, you have to do what’s best for your finances.

The more mental health professionals who say “no,” the more we’ll see real change.

Insurance companies need you to agree to work with them. Without you and others in the field, they won’t be able to sustain their own businesses. And when you stand up for yourself and refuse to work within an unfair, financially broken system, they’ll have no choice but to change.

So, here are a few takeaways from this:

• When you advocate for legislation — especially when it involves limiting clawback periods to one year — you create a meaningful impact within the mental health field.

• Saying “no” to insurance contracts that don’t meet our needs is NOT unethical; it’s how you protect yourself and encourage companies to make their plans more equitable for all.