The trappings of mental health insurance

May 19, 2014

When starting a private practice, one of the first questions we are asked is "are you going to take insurance?"

The answer is simple but the reason is complicated because of the insurance system.

Insurance companies are businesses and a business exists to make a profit.  While there are well meaning and altruistic programs within health insurance companies that truly are engaged in promoting preventative medicines, their overall goal is to pay less in claims (a claim is what you create when you access a provider and have to pay them) so that they keep as much money as possible.

Initially, this was a fair concept because insurance companies respected the services that healthcare providers performed.

But this has changed over the last 10-20 years and as a result, insurances have maximized their profits by denying to pay the claims that providers request.  The result is a broken system wherein patients pay premiums yet have to worry that the care recommended by their providers won't be covered.  On the other side, providers have to worry that the care they provided won't be reimbursed which results in delayed (or denied) payments..

The situation is far worse in mental healh because our treatment plans are less exact than in the medical model.  Many of our therapeutic techniques are based on the "art" of medicine rather than the science.  And just as you cannot measure how good artwork makes you feel, it is equally hard to make a policy guideline for which to base insurance reimbursement.

The result:  a profit driven system that increases patient and provider frustration and actually limits access to care.

For years, I have encouraged my patients and their families to contact their Congressperson and become more active in mental health and wellness.  Visit our Advocacy page to get started.


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