The Truth About Insurance Coverage

The following are reasons why mental health insurance coverage is poor to say the least. You can do your own research on the topic, as there are many articles and research websites that you can go to to learn how mental health is poorly funded. What's below, is our experience from 12+ years in the industry...

Restrictions. Commercial insurance plans (e.g. Cigna, Florida Blue, etc.), have very restrictive policies for mental health coverage.

Low # of Visits. Most plans give people 6 to 10 visits of coverage. That is a disgrace to our industry, to have a bureaucrat determine that people need to get better in 6 to 10 sessions max.

Shifting Costs. One of the biggest issues for accessing mental health is not only the $60.00 or so co-pays that insurances put in place for behavioral health services. But also the shifting of costs. They often shift the entire cost of the claim to the individual, claiming that deductible costs were not met, or out-of-pocket limits, or that the agency which provided services was not in-network with them. This puts the huge burden on the individual seeking counseling and psychiatric help, as they often end up with large bills and abandon treatment. It happens all the time. Furthermore, insurance payers make it a near impossible hurdle to join their commercial networks, and the ones that do, suffer with extremely low reimbursement rates.

Long Pay Periods. Insurance companies take their time to pay certain claims, for no valid reasons whatsoever. In 2019, for example, we had claims that were delayed for 4+ months at very least. There is always a "computer-related" reason why certain claims get delayed indefinitely, some even never paid to the agencies that provide the service.

Paybacks. Even with government-sponsored coverage for mental health, insurance companies issue retrospective reviews to agencies, which have the goal of having the agencies pay back as many claims as possible, often for random mistakes (e.g. not putting the exact time on a progress note). This is not only a huge demoralizer to the start of new agencies, but also drives down pay for the staff and causes many agencies to go bankrupt over the long term, because they cannot keep up with the games insurance companies pay.

Low Pay. Community Mental Health Agencies, which serve the most at-risk population on our country, are unable to offer competitive pay for quality mental health counselors and psychiatrists. Most staff is paid between $25.00 to $40.00 per session, when in private practice they can charge $100 or $125 instead. This creates a huge problem in recruiting mental health counselors, and especially psychiatrists, to join Community Mental Health Agencies like ours. In Florida, community mental health reimbursement rates have not been increased in over 20+ years (since 2002), and such remain one of the lowest in the nation!