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    Why it’s so difficult to find an insured therapist

    Before the pandemic, finding an insured therapist was difficult. Now the therapist and the patient The need for mental health care Searching is even more difficult.

    When Mori Pratt, a 30-year-old math teacher in Boston, was dealing with depression a few years ago, she called a nearby therapist but said they didn’t accept her insurance plan. She tried some of the listed as in the network on the insurance company’s website. I didn’t call back. Another said he was no longer insured by Mr. Pratt. And one-third couldn’t afford her schedule.

    “I wasn’t in a good place. Not seeing the therapist felt much more urgent every day,” says Pratt.

    Especially in big cities like Los Angeles, New York and Washington DC Demand for mental health care They say that many experienced therapists are too strong to accept insurance plans. They can easily fill their practice with out-of-pocket patients, they add. Insurance therapists are often booked. And in many small towns and regions, there are few mental health professionals. Finding an insured provider or lowering the price in other ways is possible, but if you’re already tackling mental health issues, it’s often a hassle.

    Paying from your pocket for individual weekly treatments can amount to thousands of dollars a year. In major cities, tolls for experienced clinical psychologists can be as high as $ 300 for a 45-minute session. Typical fees for sessions with licensed clinical social workers range between $ 120 and $ 180, says Anna Mangum, deputy director of the National Social Workers Association program. Patients receiving benefits outside the network may be eligible for a partial refund of the invoice. However, using an in-network provider often means that the patient only has to pay a small out-of-pocket cost.

    Psychologists, social workers, and psychiatrists who do not accept insurance say that insurance companies have too low reimbursement rates. Insurers typically pay social workers about one-third to one-half of what they can charge at their own expense, Mangum said. Some therapists have also complained about paperwork and restrictions on the types of care covered.

    Ken Goodman, a Los Angeles-licensed clinical social worker and board member of the Anxiety and Depression Association, said, “If you’re good enough, well-marketed, and in demand, don’t take out insurance. It’s just an economic decision. ” America’s. Goodman says he quit his last insurance company about a year ago. “Just accepting cash makes you double your income.”

    Hurdle to find a therapist

    According to a 2016 survey of more than 3,100 participants (latest data available) conducted by the National Federation of Mental Illness Families, approximately 34% of people with private insurance are covered. It states that it is difficult to find a therapist who accepts. -Health advocacy group. By comparison, 9% said it was difficult to find a primary care provider in the network.

    Office visits to mental health providers can be more than five times more off-network than visits to primary care providers, according to a 2019 report from consulting firm Milliman, which analyzed insurance claim data. In 2017, 17.2% of mental health office visits were off-network, compared to 3.2% of primary care visits, Milliman reported.

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    Many psychologists accept insurance early in their careers while building practices, but some clinical psychologists reduce or drop insurance as they gain experience and word-of-mouth referrals, says the American clinical psychologist. Says Limbu Fuka, senior director of the Psychological Association. A study published in 2014 at JAMA Psychiatry using data collected by the Center for Disease Control and Prevention found that approximately 55% of psychiatrists had private health insurance between 2009 and 2010. About 89% of doctors in other specialties have private insurance. Saul Levin, CEO and Medical Director of the American Psychiatric Association, said the number of psychiatrists has probably not changed much since then due to low repayment rates and administrative issues.

    What the patient can do

    If you are insured and available in your area and cannot find a therapist who can properly treat your condition, you may be able to arrange what is called a single case contract between an off-network provider and your insurance. .. society.

    Aarti Gupta, a clinical psychologist in Palo Alto, California, said he had negotiated these agreements with several patients, including suicidal teens and patients with rare symptoms such as trichotillomania and trichotillomania. increase. Dr. Gupta stopped taking insurance plans in 2017, about a year after his private practice.

    Telemedicine can provide access In a pool of a wider range of providers, including therapists far from you.

    And some uninsured therapists have a sliding scale. For example, Dr. Gupta has reserved two low-priced slots on his schedule. And, of course, make sure you’re submitting eligible off-network benefits.

    What insurance companies are doing about it

    Insurance companies say they are trying to increase access to therapists.

    National anthem Ltd

    In the early days of the pandemic, he said he added about 2,000 providers to the telemedicine platform to meet growing demand.

    UnitedHealth Group Inc.

    The network of mental health care providers has grown by 50% over the last five years, with more than 260,000 nationwide.

    Regarding the therapist’s dissatisfaction with low repayment rates, the Anthem Health Plan said in a statement, “We regularly review repayments to ensure that providers receive market prices.” Margaret-Mary Wilson, Associate Chief Medical Officer, UnitedHealth Group, said the company is using data on how patients are improving to financially “reward providers for better outcomes.” It states that there is.

    Success, with leg work

    Boston teacher Pratt eventually found a therapist with her insurance. She says she was looking for a therapist in the network again this summer after she retired.

    She says she sent a detailed email to 20 therapists. 16 did not reply. The two replied that they were not accepting new patients. But there was space in the two. Pratt says she chose one and met her new therapist twice. She says legwork was worth it. For each session, she pays only $ 20.

    Write to Andrea Petersen andrea.petersen@wsj.com

    Copyright © 2021 DowJones & Company, Inc. all rights reserved. 87990cbe856818d5eddac44c7b1cdeb8

    Why it’s so difficult to find an insured therapist

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