Shrink Rap: Getting Adequate Medical Care, Not Easy

Personally I don’t know a single human being who has never had a significant emotional problem or challenge; in other words, it’s a part of the human condition to suffer, sometimes deeply, and to need support, counsel, a safe place to air one’s thoughts and feelings and receive honest feedback along with relevant information. Some of us have wise family members, including elders, who are happy to listen and give counsel. Some of us have strong friends and spouses for emotional support. But sometimes, we need someone who is neutral, intelligent, educated, compassionate, and informed to help us sort things out, a therapist.

I believe the problem is less one of stigma, but more of access and affordability. Mental health resources are not available everywhere and even when they are, they are not accessible to many. Insurance companies still have special exclusions and limitations imposed on mental health care alone, completely differently from the way other medical claims and issues are handled. I have actually had to call five different insurance companies to find out which of them is handling mental health care for the umbrella company. If it is difficult for a professional me to find out about a patient’s coverage, it is even harder for the patient himself to find out. You may get what you think is a great insurance policy and the find out most therapists in your area are excluded.

From the therapist’s point of view, insurance companies try to recruit “in network” therapists (and other doctors) to sign contracts for dramatically reduced fees. Unfortunately, it is also, then, the responsibility of that “in network” doctor to bill and collect from the insurance companies. Most insurance companies make it so time consuming and difficult to get paid, small practices are forced to spend an inordinate amount of time and money just to collect for services they have already provided. One research study I read revealed that about 17% of all medical claims filed were erroneously rejected and mishandled by insurance companies in the United States. That would be millions of claims every day that were sent back to the doctors to try to figure out, spend hours on the phone, and resubmit.

If you do manage to find an outpatient or inpatient program that meets your needs, you will then have to fight with your insurance company to jump through hoops and find many reasons why they will not cover the service. As a doctor, I find that insurance companies actually believe they can determine what services I can or cannot give to a patient and I have to repeatedly remind them that they do not determine what I do, that’s my job with the patient. The insurer may refuse to pay for the treatment, but they never make professional decisions for me. But in fact, because most people cannot pay cash for the help they receive, insurance companies are now making medical policy and decisions. That is wrong.

Because mental health care is now dominated by pharmaceutical treatment of problems, psychotherapy is less emphasized and drugs more prolific. However, research also shows that administration of an anti-depressant drug, for example, is not statistically effective without psychotherapy while taking the drug.  Also, often psychotherapy is sufficient to preclude the use of drugs and to prevent hospitalization.

Getting mental health care in the United States is difficult and often like bushwhacking one’s way through a jungle, with very little help from anyone to figure out direction or strategy. I don’t believe that stigma prevents the vast majority of people from getting help. It is primarily the insurance companies, the lack of adequate coverage, and the exclusions and limitations, that prevent people from accessing mental health care.

What you as an individual can do is to convince your employer or HR office to provide good mental health coverage for both in- and out of network providers and strive for universal coverage instead of private insurance companies, who are making record profits by denying so much good care to people who need help.