One of us is a national behavioral health advocate whose peer support work ignited a decade-long journey to reform the system. As a peer supporter, I have worked with several youths and young adults who became entangled in insurance nightmares. One person’s therapist stopped taking insurance after two years because she was not getting paid on time and was losing money on the low reimbursement. They could not afford to pay and went without care for the remainder of their college education. Another young adult turned 26 and found that their therapist of six years was suddenly out-of-network now that they were off their parents’ insurance plan. They were forced to find a new therapist, and over half of the providers on the plan-provided list never responded.
One of us has worked as a social worker and knows the aggravation, and even deadliness, of not receiving care. A Bowman Family Foundation report found that 57% of people seeking mental health or substance use care were unable to on at least one occasion between January 2019 and April 2022.
If you or anyone you love has ever needed mental health care, you probably have a similar story of frustration and difficulty finding a mental health provider who takes your insurance or does not have an impossibly long wait. The good news is that we all can improve this experience and get greater access to care by voicing our support for the Biden Administration’s July proposed rule implementing the Mental Health Parity and Addiction Equity Act (MHPAEA).
Enacted 15 years ago, MHPAEA directed insurers to treat mental and physical health equally in insurance practices. Families celebrated thinking they would finally have access to critical mental health and substance use care. That never happened. Since then, insurers have poked so many holes in the Act that accessing mental health and substance use care is not only increasingly difficult for everyone, but grievous burdens are placed on children and their caregivers during a mental health crisis.
Insurers are quick to cite the behavioral health workforce shortage as an excuse while ignoring how their practices have contributed to the shortage, including paying very low rates compared to the market, keeping networks closed, designing burdensome prior authorization requirements, and delaying and denying payment. The proposed rule would significantly strengthen parity enforcement, deny insurers from using more restrictive prior authorization, reduce arbitrary barriers and get us closer to the original promise of equal care.
Insurers make up standards to deny claims. A district court in Wit v. United Behavioral Health found that one of the nation’s largest insurers was writing its medical necessity standards specifically with the intent to deny behavioral health care and save money, ignoring well-established guidelines from medical societies. As the Administration notes in a Fact Sheet, the proposed rule would “make clear that health plans need to evaluate the outcomes of their coverage rules to make sure people have equivalent access between their mental health and medical benefits.”
Insurers also get away with unchecked “ghost networks.” One recent study in Health Affairs of the Oregon Medicaid program found that more than two-thirds of mental health prescribers and 59% of other mental health professionals listed in the state’s insurance directories were “ghosts.” That is, insurer plans appear to offer many in-network mental health choices, but the reality is that these lists comprise disconnected lines, providers not accepting new patients and out-of-pocket options. The proposed rule would require “evaluating the health plan’s actual provider network.”
These changes cannot come fast enough. During an extraordinary youth crisis, our nation’s youngest feel the effects.
Insurance data show that children’s mental health visits are 1,000% more likely to be out-of-network than physical health visits, which means families are forced to pay out of pocket or even skip needed mental health care.
We need the toughest regulations possible, especially for our youth struggling with their mental health. Numbers from Mental Health America Screening tell us that 38% of screeners seeking help for mental health concerns in the U.S. last year were under age 18, 48% of youth depression screeners reported frequent suicidal ideation, and suicidal ideation rates are highest among youth, especially LGBTQ+ youth of color. The Administration should strengthen the proposed rule to ensure there are no exceptions to a careful review of whether any insurance practice is treating people fairly.
Critics of the rule say that it will impose reporting burdens on employers and insurers. However, it will not be a burden if their practices are fair, and they treat mental and physical health similarly. The true burden is on families who must pay high costs or forego care.
If you are serious about responding to the youth mental health crisis, you must be serious about requiring parity in care. Now is the time for all of us, from youth to adults, to raise our voices, submit comments on this new parity rule, and tell insurance providers that we will no longer accept less help for mental health and addiction care. Click here to submit a comment.
Kenna Chic is a national behavioral health advocate, former president of the Project Lighthouse Peer-Support System, and former member of MHA’s Collegiate Mental Health Innovation Council. Schroeder Stribling is president and CEO of Mental Health America and a former social worker.
