Reporting Highlights
- An Insurer Sanctioned: Three states found United’s algorithmic system to limit mental health coverage illegal; when they fought it, the insurer agreed to restrict it.
- A Patchwork Problem: The company is policing mental health care with arbitrary thresholds and cost-driven targets, highlighting a key flaw in the U.S. regulatory structure.
- United’s Playbook Revealed: The poorest and most vulnerable patients are now most at risk of losing mental health care coverage as United targets them for cost savings.
Testimony by Carter J Carter who became a therapist to help young people.
Rosemarie Marmor wanted to support victims of emotional trauma.
Kendra F. Dunlap wanted to serve people of color.
To understand the forces that drive even the most well-intentioned therapists from insurance networks, ProPublica plunged into a problem most often explored in statistics and one-off perspectives. Reporters spoke to hundreds of providers in nearly all 50 states, from rural communities to big cities.
The interviews underscore how the nation’s insurers — quietly, and with minimal pushback from lawmakers and regulators — have assumed an outsize role in mental health care.
It is often the insurers, not the therapists, that determine who can get treatment, what kind they can get, and for how long. More than a dozen therapists said insurers urged them to reduce care when their patients were on the brink of harm, including suicide.
All the while, providers struggled to stay in business as insurers withheld reimbursements that sometimes came months late. Some spent hours a week chasing down the meager payments, listening to music and sending faxes into the abyss.
Several insurers told ProPublica that they are committed to ensuring access to mental health providers, emphasizing that their plans are in compliance with state and federal laws. Insurers also said they have practices in place to make sure reimbursement rates reflect market value and to support and retain providers, for which they continually recruit.
Therapists have tried to stick it out.
They have forgone denied payments.
They have taken second jobs.
They have sought therapy for their own support.
But the hundreds who spoke with ProPublica said they each faced a moment in which they decided they had to leave the network.
Why I left the network
Health Care
What Mental Health Care Protections Exist in Your State?
Insurers have wide latitude on when and how they can deny mental health care. We looked at the laws in all 50 states and found that some are charting new paths to secure mental health care access.
by Annie Waldman and Maya Miller
Co-published with NPR News
Aug. 27, 7 a.m. EDT
Series: America’s Mental Barrier: How Insurers Interfere With Mental Health Care
Accessing mental health care can be a harrowing ordeal. Even if a patient finds a therapist in their network, their insurance company can overrule that therapist and decide the prescribed treatment isn’t medically necessary.
This kind of interference is driving mental health professionals to flee networks, which makes treatment hard to find and puts patients in harm’s way.
ProPublica sought to understand what legal protections patients have against insurers impeding their mental health care.
Most Americans — more than 164 million of them — have insurance plans through employers. These are generally regulated by federal law.
Although the law requires insurers to offer the same access to mental health care as to physical care, it doesn’t require them to rely on evidence-based guidelines or those endorsed by professional societies in determining medical necessity. Instead, when deciding what to pay for, the government allows insurers to set their own standards.
“If insurers are allowed to home bake their own medical necessity standards, you can pretty much bet that they’re going to be infected by financial conflicts of interest,” said California psychotherapist and attorney Meiram Bendat, who specializes in protecting access to mental health treatment.
Federal lawmakers who want to boost patient protections could look to their counterparts in states who are pioneering stronger laws.
Although these state laws govern only plans under state jurisdiction, such as individual or small-group policies purchased through state marketplaces, experts told ProPublica they could, when enforced, serve as a model for broader legislation.
“States are laboratories for innovation,” said Lauren Finke, senior director of policy at The Kennedy Forum, a nonprofit that has advocated for state legislation that improves access to mental health care. “States can take it forward and use it for proof of concept, and then that can absolutely be reflected at the federal level.”
ProPublica reporters delved into the laws in all 50 states to determine how some are trying to chart new paths to secure mental health care access.
Many of the new protections are only just starting to be enforced, but ProPublica found that a few states have begun punishing companies for violations and forcing them into compliance.
Because of the Interference
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