A new investigation from ProPublica sheds light on the shocking lengths to which some corporate insurers go to avoid paying for mental health services that Americans desperately need.
Certain corporate insurance companies underpay and obstruct providers and refuse to approve coverage for patients’ treatments. They may intervene to pressure providers to reduce or prematurely terminate patients’ care.
While federal law requires corporate insurers to provide the same access to mental and physical healthcare, ProPublica found that some insurers go to great lengths to avoid paying for mental health services because it’s bad for their bottom lines:
- “The way to look at mental health care from an insurance perspective is: I don’t want to attract those people. I am never going to make money on them,” said Ron Howrigon, a consultant who used to manage contracts with providers for major insurers. “One way to get rid of those people or not get them is to not have a great network.”
According to ProPublica, some insurers pressure providers to cut off care, refuse to authorize it, or insist that patients aren’t sick enough to justify treatment, even when this contradicts clinical documentation attesting to the patient’s needs. Here is some of what the investigation found:
- “Fresh grief issues like the death of the spouse, they would still say things like, ‘When will you be terminating treatment?’” – Beth Green, a psychologist in San Diego, California
- “In addition to cutting off therapy, they are pressuring providers to cap the length of their sessions to 45 minutes, even when the patients require more time. Therapists told us that they have seen their patients sink deeper into depression, suffer worsening panic attacks and wind up in emergency rooms after insurers refused to cover treatment.” “I work with trauma clients, and I can’t open that trauma up and put it back in a box in 45 minutes.” – Elizabeth Fisher, a psychologist in Tampa, Florida
These insurers systematically underpaid providers, attempting to obstruct and prevent proper reimbursement at every step of the process. In many cases, payments were delayed by months or years, and providers were forced to go into debt or forgo their own salary just to scrape by. ProPublica reported:
- “Insurance reimbursement barely covered the gas it took to get to my office.” – Kayce Hodos, therapist in Wake Forest, North Carolina
- “With problematic insurers, it takes three, four or five months to get paid, and it’s costing me as a business. I see clients for eight hours and then I spend four hours on the phone with insurers.” – Marsinah Ramirez Buchan, therapist in Bakersfield, California
- “I actually had to get a whole daytime job as a school social worker, because I really cannot afford to rely on insurance companies to pay my bills.” – Shaina Helm, therapist in Chicago, Illinois
- “I am out $20,000-plus, and so it is a very, very big deal. I continued paying my staff, but I was not taking a salary myself.” – Rhonda Stewart Jones, therapist in Alexandria, Virginia
- “The amount of time that you spend waiting on the phone and then they tell you that you’re connected to the wrong place, the wrong person, the wrong department.” – Philip Bender, psychologist in New York City
- “Coding errors resulted in unpaid claims, and I spent one to two hours every week to get it resolved. It led to a lot of frustration and took time away from clients.” – Kendra F. Dunlap, therapist in Berkeley, California
It’s well-documented that many corporate insurers routinely delay and deny access to essential medical care to pad their profits.
Unless lawmakers take action to address these practices and hold corporate insurers accountable for their role in limiting patients’ access to essential mental health services, the crisis will only become worse. Congress must halt these abusive practices to ensure patients have access to necessary care.