One of us is a national behavioral health advocate whose peer advocacy work began a decade-long journey to reform the system. As a peer supporter, I have worked with several youth and young adults who became trapped in insurance nightmares. One person’s therapist stopped carrying insurance after two years because he wasn’t getting paid on time and was losing money due to low reimbursement. They could not afford to pay and spent the rest of their college education without medical care. Another young adult turned 26 and discovered that his therapist of six years was suddenly out of network now that they were no longer on his parents’ insurance plan. They were forced to look for a new therapist and more than half of the providers on the list provided by the plan never responded.
One of us has worked as a social worker and knows the aggravation, and even lethality, of not receiving care. A report from the Bowman Family Foundation found that 57% of people who sought mental health or substance use care were unable to on at least one occasion between January 2019 and April 2022.
If you or a loved one has ever needed mental health care, you probably have a similar story of frustration and difficulty finding a mental health provider who accepts your insurance or doesn’t have an incredibly long wait. The good news is that we can all improve this experience and gain greater access to care by expressing our support for the Biden administration’s July decision. proposed rule implementing the Mental Health Parity and Addictions Equity Act (MHPAEA).
Enacted 15 years ago, the MHPAEA directed insurers to treat physical and mental 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 made so many loopholes in the law that access to mental health and substance use care is not only becoming more difficult for everyone, but is also placing a heavy burden on children and their caregivers during an mental health crisis.
Insurers are quick to cite a shortage of behavioral health staff as an excuse, while ignoring how their practices have contributed to the shortage, including paying very low rates compared to the market, maintaining closed networks, designing burdensome prior authorization requirements and the delay and denial of payments. The proposed rule would significantly strengthen parity enforcement, deny insurers the use of more restrictive prior authorizations, reduce arbitrary barriers, and move us closer to the original promise of equal care.
Insurers develop standards for denying claims. A district court in Wit v. United Behavioral Health determined that one of the nation’s largest insurers was writing its medical necessity standards specifically with the intent of denying behavioral health care and saving money, ignoring well-established guidelines from medical societies. As the Administration points out in a fact sheetThe proposed rule “would make clear that health plans must evaluate the results of their coverage rules to ensure that people have equivalent access between their medical and mental health benefits.”
Insurers also get away with uncontrolled “ghost networks.” A 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 options, but the reality is that these lists include 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 can’t come fast enough. During an extraordinary youth crisis, our nation’s youngest are feeling the effects.
Insurance data shows children’s mental health visits are 1000% more likely to be off the grid than physical health visits, meaning families are forced to pay out of pocket or even skip needed mental health care.
We need the strictest regulations possible, especially for our young people who struggle with their mental health. Mental Health America Screening numbers tell us that 38% of examiners who sought help for mental health problems in the US last year were under 18 years old., 48% of youth depression screeners reported frequent suicidal ideation, and rates of suicidal ideation are higher among youth, especially LGBTQ+ youth of color. The Administration should strengthen the proposed rule to ensure that there are no exceptions to a careful review of whether any insurance practice is treating people fairly.
Critics of the rule say it will impose reporting burdens on employers and insurers. However, it won’t be a burden if your practices are fair and treat physical and mental health similarly. The real burden falls on families who must pay high costs or forego care.
If you really want to respond to the youth mental health crisis, you must take the demand for parity in care seriously. Now is the time for all of us, from young people 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, past president of the Lighthouse Peer-Support System Project, and former member of MHA’s University Mental Health Innovation Council. Schroeder Stribling is president and CEO of Mental Health America and a former social worker.
