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Credit Claims For Boston Social Services And Counseling Professionals: Legal Considerations For Career Advancement – Iris (Yi Youn) Kim is a writer and recent USC graduate living in Los Angeles. Her writing has appeared in Slate, TIME, Salon, Delish, and Business Insider. Find her online at @iris_kim7 and www.iris-kim.com.
When you’re struggling with your mental health, navigating the system to find affordable therapy makes it even more difficult. That’s the case with Emily K., a 25-year-old who has a specific type of OCD, or obsessive-compulsive disorder. Diagnosed at age 17, she never found a therapist online, and only briefly had a low-paying therapist.
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Now unemployed, she pays $450 a month for continued insurance through her previous job, plus $175 for her therapist every other week. Although she can get a $50 reimbursement each session from her insurance, the process requires submitting superbills or itemized invoices from her provider and takes about three months. Her entire unemployment check goes toward paying rent, so Emily is scrambling to get funding for her anti-depressants and mental health treatment. “It’s eating into my savings,” Emily said.
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This story is part of Priced Out, reporting on how real people deal with the high cost of living in the US.
Most one-hour psychotherapy sessions in the US range from $100 to $200 or more in major metropolitan areas. Although some major insurance plans cover mental health benefits, therapists are paid so low that they are dropped from insurance panels. In the end, it’s patients who pay the price, coughing up rising insurance premiums as they face a shortage of in-network practitioners—or finding out-of-network providers, which are far more common, are simply too expensive.
Paying out of pocket for weekly therapy sessions can add up to thousands of dollars a year. Individuals seeking affordable mental health care are left relying on a network of online services, free clinics, support groups, educational programs, nonprofits, and low-cost counselors.
Yet nearly half of the 60 million people in the U.S. with mental health problems go untreated, according to the advocacy group National Alliance on Mental Illness, or NAMI. The situation is particularly dire for black people and historically disadvantaged groups, who are more likely to be uninsured and receive poorer care, or no treatment at all. Racial and ethnic minorities also face discrimination in the mental health care system, lack of diversity among practitioners, and stigma in their communities related to mental illness.
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The high cost of mental health services has been in the spotlight during the pandemic. Rates of depression and anxiety have more than tripled, from 9% in early 2020 to 33% in 2021, affecting one in three US adults, according to research from Boston University Public Health. The surge in demand for mental health treatment has been acutely felt by advocates for the NAMI Helpline, a free, national peer support service that provides information and resources to people in need. There has been a 65% to 75% increase in help-seekers since March 2020, according to Dawn Brown, National Director of NAMI HelpLine Services.
As mental illness affects people’s lives more broadly—financially, socially, and physiologically—experts see that impact spreading to society as a whole, becoming interconnected with disability, addiction, homelessness, incarceration, and increased suicide rates. Politicians are starting to take the mental health crisis more seriously, but patients need to come together to put more pressure on insurance companies, said Margie Ryerson, a licensed marriage and family therapist in San Francisco.
Asking for help and knowing where to look are key first steps. “People are reaching for non-traditional sources of support and guidance,” Brown said, noting that emotional support is an effective and key component of recovery. “Peer support is an option that can bring people through really difficult times and give them guidance and hope,” she said.
Audrey Chu was a freshman in college when she sought treatment for trauma related to a sexual assault. Chu found quality help through the university’s health system, paying $20 for each session. But after she left school, she began taking medication that required supervision by a psychiatrist, who was not insured. Each 20-minute session cost her $300 out of pocket.
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Insured patients regularly face barriers to finding a mental health provider online. In a 2016 NAMI survey, 34% of people with private insurance said they had difficulty finding a therapist who accepted their coverage. In Chu’s case, she later found a therapist who was covered and charged $71 for each session. But two years later, she discovered that her therapist was in a constant battle with the insurance company to get reimbursed.
Typically, in-network therapists receive a very low flat rate of reimbursement per session, which is determined by insurance providers. In the San Francisco Bay Area, where the cost of living is astronomical, psychologist Alice LoCicero said private doctors paid by insurance barely make a living. Insurance therapists are also burdened with mandatory claims documentation, unpaid hours.
Ryerson, who has been a therapist for about 30 years, started accepting insurance, but soon realized the rate wasn’t worth the extra work. “After 10 years of practice, my insurance reimbursement has not increased at all,” she said.
Ryerson had a large number of patients with eating disorders, and for those with insurance, she was required to submit paperwork to insurance representatives to justify continued care. She also made additional consultations with psychiatrists and nutritionists to coordinate the treatment of these patients, adding hours to her day.
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Because of little incentive for practitioners, an increasing number of therapists stopped accepting insurance. It was a tough choice for Ryerson, who said insurance companies should start making a “good faith effort” to negotiate with mental health practitioners and make it more attractive by offering higher rates, which in turn would benefit patients.
Insurance companies also limit the number of therapy sessions that are covered, while clinics mandate limited sessions, which can make treatment ineffective. Ellie Bendetson, a pediatric occupational therapist, described how when she started working at an insurance-based clinic, she had to limit her time talking with patients’ families because insurance only covered one 50-minute session per week. The clinic was obliged to charge for each 10-minute call. “We constantly had to prove to insurance that the child needed treatment,” Bendetson said. “What I wanted to do was make sure they had a high quality of life, but that goes beyond what insurance covers.”
She eventually moved to a private clinic, where patients were encouraged to submit their bills for each session to their health insurance to get some money back. “Typically, the ones who get reimbursed are the ones who know how to use the system,” Bendetson said. Fortunately, the clinic’s pro bono insurance advocacy program helps patients file these claims. “We need to help patients advocate for themselves, but until they are educated, the insurance companies will always have the upper hand,” she said.
During the pandemic, insurance companies began loosening coverage limits and waivers for remote mental health counseling, or telehealth. For Emily K., it was a blessing because it expanded the range of specialists she could see. “It’s really helpful that my insurance has started covering remote sessions because of the pandemic,” she said. “There are a lot more options and I can see people who are further away from where I live.”
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Chu also began seeing a psychiatrist through a virtual clinic that accepted her insurance, with a $40 copayment. But Chu noticed that the quality of the virtual sessions was significantly lower than the offline clinic she had previously attended. “They rushed through a checklist during my sessions. My previous doctor asked detailed questions about how my medications were affecting me,” she said. Still, she was grateful for the convenience and affordability.
Teletherapy apps provide affordable options for people seeking mental health support, which is helpful, Brown says. But the bigger question is whether Congress will hold insurance companies accountable for what’s called “parity,” the idea that mental health and addiction care is covered on the same level as care for other health conditions. “It should be as easy and affordable to find a licensed clinical social worker or psychologist as it is to find an optometrist or pediatrician,” Brown said. NAMI’s policy advocacy efforts focused on implementing parity.
In the meantime, patients in need of affordable mental health care can try a variety of support groups, services, and treatment options that are low-cost or free. Given that free or affordable arrangements are often hard to come by, psychologist Alice LoCicero said individuals should make sure to go with something that works for them and not just settle for the first option they find. Therapy and Spiritual Care in a Broken World: Transforming a Community of Healers Thank you for a fantastic conference! Watch the conference video here. Each presenter’s slides are linked below below each presentation summary. The COVID-19 pandemic. Systemic oppression. Political upheaval. Assessment of human rights. Increased mental health
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