It’s estimated that almost 1 in 5 people suffer from some form of mental illness in the United States. With such widespread prevalence of mental illness, finding a mental health care provider should be easy. Ask anyone around you however and they’ll tell you that finding a good therapist is really hard. It can feel time-consuming, emotionally draining, and expensive. Why is our healthcare system unable to provide us the simple access to mental health care we need?
Before we dive into some of the more systemic problems in accessing mental health care, let’s start with the obvious issue of stigma. Because mental health is deeply personal, it’s pretty unlikely that you’ll hear your co-workers rave about how great their therapist is. It is easy to feel alone in your concerns about mental health. Open up to your personal network and you may find cousins, friends, and co-workers who have already embarked on their own mental health journeys.
Among some households in America, mental health is not always well received. Some parents call their children weak when they express concerns over mental health. Others may think that their children’s mental health reflects poorly on them as parents. Some cultures may not have well-known concepts for more severe mental illnesses. Family members with diseases such as bipolar disorder or schizophrenia may be treated poorly because they’re seen as afflicted by bad karma or evil spirits.
Starting the mental health care journey
You’ve moved past these challenges and now you’re taking your mental health into your own hands. Now what?
Mental health isn’t transactional. It is not like getting your arm put in a cast or getting stitches for a deep cut. While medication may be involved, a lot of mental healthcare is developing skills and altering neural patterns to change unhealthy reactions and patterns of thoughts into productive healthy ones. It is incredibly powerful, but it takes time.
Much like an athlete who has to take care of their physical health and hone their skills through repetition, a person engaging in mental health does so through healthy behaviors and cognitive and emotional skill development.
The most common way people start their mental health journey is by asking their general physician for a referral. If you’re lucky enough to have a physician who takes your concerns seriously, you’ll likely find yourself on a large waitlist behind hundreds of other Americans who’ve tried the same thing. Medical clinics and hospitals around the country do not have enough mental health care providers to meet the demand. This problem is so bad in fact that often you may not even be able to see a provider unless you indicate that you are dealing with suicidal thoughts.
Say you, like many other people, don’t want to wait a month or longer to get the care you deserve. The next step in the process is to find a mental health care provider who will take your insurance. Sounds simple enough, except that nearly half of all mental health care providers in California alone don’t take any form of insurance!
People are seeking mental health care and therapists want to help. Why are insurers, the entities that are supposed to bring them together, absent from the equation?
Problems with insurance
If you ask the insurance companies, they’ll say that there’s a shortage of therapists. While that’s true in the state of California as a whole, the answer isn’t that simple. In fact, while there are not enough qualified clinical therapists in rural areas of California, there are many mental health care providers in the more dense urban areas of the San Francisco Bay Area and Los Angeles. They just don’t want to work with insurance companies.
Therapists give several reasons why it’s challenging to work with insurance.
First is an issue of money. Mental health care providers receive some of the lowest reimbursement amounts from insurers. It’s common for a therapist to only receive $60-$80 from insurance in places like San Francisco where the market rate can be $150-$200 per one-hour session or more. We’ve even heard cases of these rates being even lower depending on how the provider chooses to bill the insurance company.
Adding to this issue is the paperwork required by insurers when providing mental health care. When a provider files for insurance reimbursement, it can take up to an hour to fill out the insurance paperwork per hour of therapy provided. It then takes the insurance company 4-6 weeks after the appointment to pay the therapist. When looking at an hourly rate, a therapist charging $120 per session can actually expect to be making something like half that. Factoring in low reimbursement rates from insurance companies and we can start to see why therapists aren’t keen on working with insurance companies.
Lastly, and perhaps the most frustrating to motivated providers, is the fact that insurers may not even accept the therapist on their panel. To be on an insurance panel means you are listed in the insurance network and can accept a patient’s insurance. The benefit for health care providers has traditionally been more referrals to be a part of these networks at the cost of providing care at slightly lower costs. When these therapists apply to be on the panel, the insurance companies tell them that there are already too many providers in that area already.
And yet, when speaking with people who have sought therapists within their own insurance network directories, they can’t seem to find any therapists who’ll take them. The listed therapists are completely unavailable, with waiting lists that are months long. Sometimes the providers may not even exist!
It’s not that the therapist profiles are fictitious. However, there have been reported cases of mental health care providers listed on insurance networks who have retired or are no longer even alive! This problem has become common enough it’s engendered its own term: ghost network. A ghost network describes an insurance network that seems large and full of clinicians in the network but in reality is full of providers who aren’t practicing or actually part of the insurance plan. Our most recent searches on Kaiser’s network as part of our therapist finding service revealed that almost all of the therapists listed on the first 3-5 pages were either:
not accepting Kaiser insurance any longer
not accepting clients at all
duplicates of previous results
Challenges with internet searches
The next step is often a generic internet search. I’ll just search for a therapist who takes my insurance! You may soon be asking yourself “why does it say all these therapists on Psychology Today or GoodTherapy say they take insurance?” If what you’re saying is true, I would expect only a handful of them to take my insurance!
Well there are two major things at play here.
Firstly, a lot of therapist bios can be misleading. The bio may say something like Premera (Out-Of-Network) Insurance accepted. This doesn’t mean that the provider takes your insurance. The therapist will actually provide you a statement for reimbursement. This document, otherwise known as a superbill, is basically an invoice describing the treatment you received. You must pay the therapist their full-rate up front in cash and then submit this superbill along with a form to your insurance for reimbursement. For insurance providers such as Cigna and Blue Shield Blue Cross, this claim will take 60 business days to be processed and for you to be reimbursed.
Even if this isn’t the case at hand, therapist bios are often out-of-date or unhelpful to the general public. Your therapist may have accepted your insurance at one point and didn’t update their profile when they decided to stop accepting it.
Therapist bios can also be confusing for the average person looking for help. You may find profiles where a therapist lists every single issue as something they treat. The profile may also list many different types of treatment methodologies such as Humanistic Therapy, Gestalt Therapy, or Intensive Short-Term Dynamic Psychotherapy. Combined with a barrage of information and acronyms such as LCSW, EMDR, CBT, or LMFT, it’s easy to be overwhelmed. These providers often have specialties that are only made clear once you’ve contacted them. Our recommendation is to avoid therapists whose profiles appear too general. If you see a provider who says they tackle everything from Asperger's Syndrome to Transgender issues, you may find that they’re not as effective at tackling your specific issue as someone who focuses on issues of anxiety, racial identity, or whatever challenges you face.
Regardless of whether you pay with insurance or out-of-pocket, it’s not uncommon to hear that someone has contacted 15-20 different therapists via phone or email, waited days or weeks to hear back, and finally found 3-5 therapists who are currently taking new clients. Adding up all this effort, it can take someone weeks to their first appointment, only to find out the therapist wasn’t a good fit.
How to find a good fit
Problems of fit often occur when a person is unfamiliar with the process. This happens when the client doesn’t know what they’re looking for in therapy and they start seeing the first therapist they find. The person may not have been aware that they could ask for a free phone consultation to get an idea of whether the therapist was a good fit. Often a person will wait far too long to terminate or change therapists after they’ve felt like the fit wasn’t good. Remember, you are paying money to improve your well-being. If you aren’t getting the help you need, find someone else.
All told, the process can be really challenging, but with a structure in place, you can make this endeavor a lot less painful. And in the end, you’ll be happy you did so. If you’d like help embarking on your mental health care journey, you can read the guide we’ll be publishing soon!