Insurance Companies Are Incentivized to Deny Mental Health Care
“I just told you this client attempted suicide a week ago, she has no coping skills, and nowhere else to go. Are you seriously suggesting that she’s ready to step–”
“--My finding is that the client is no longer a risk and is ready to step down to intensive outpatient. Goodbye.”
Click. I looked down at my phone: Call Ended.
I’d been pacing back and forth in my office for the last 15 minutes, arguing with an insurance company doctor over whether a patient could stay at our treatment center. Their answer: no.
Even though this kind of phone call was a daily occurrence for me, I was angry. How could this doctor be so callous with the life of a human being?
Of course, this doctor didn’t actually know the human being in question. To him, she was just a chart. To me, she was a real person, one who’d be crying in my office later that afternoon when I explained to her that she’d have to leave residential care and cope as best she could while attending outpatient groups.
I let out a deep sigh as I sat back down at my computer to draft an email to the team, letting them know the outcome of the call. I felt defeated. I was also worried that our patient would end up back in the hospital–or worse.
It was the middle of the pandemic, and I was working as the Clinical Director of a residential treatment center for women with severe mental health issues. And every day, I had phone calls known as “peer reviews,” where I’d argue with doctors employed by insurance companies about whether our clients needed the care they were getting.
You might be asking yourself, what kind of doctor goes all the way through medical school and then decides to work for an insurance company, denying care for a living?
Great question. In my experience, some of them were genuinely kind and thoughtful individuals who were sincerely interested in clients’ welfare and willing to work with me to develop a reasonable plan. I genuinely appreciated those doctors and looked forward to my calls with them.
But some of the doctors were, frankly, assholes. They didn’t listen to what I had to say. They interrupted and talked over me. They hung up on me and then misrepresented what we’d talked about in their written notes. In a way, it made sense: their jobs were to save the company money by denying care whenever possible.
Everyone who’s dealt with the U.S. health insurance system knows that insurance companies have a financial incentive to minimize their costs. But few people realize how this affects patients with mental health problems. Unfortunately, as a result of insurance companies’ decisions, patients can and do die.
Suicide and drug overdoses cause hundreds of thousands of deaths per year, and those numbers have only risen since the beginning of the pandemic. That means that mental health services can be lifesaving–if patients can access them.
Everyone knows that mental health and substance use problems are at epidemic levels. There’s more awareness and acceptance of mental health issues than ever before. There are even parity laws in place to make mental health care equal in priority to physical health.
But despite those laws, insurance companies are still balking at providing resources for mental health care, and I believe it’s because their profit motive is baked into the system. Whatever these companies say about their “mission” or “values,” they’re private, for-profit corporations, with only one real incentive: to make money for their shareholders.
In 2021, UnitedHealthcare paid 15.6 million dollars to settle federal and state investigations for violating the Mental Health Parity and Addiction Equity Act (MHPAEA) by wrongfully denying claims for outpatient psychotherapy. And Aetna was recently hit with a class-action lawsuit over denying residential care.
Perhaps these kinds of regulatory actions will have an impact on insurers’ behavior over time.
On the other hand, I can’t help but think that $15 million is a slap on the wrist for a company like UnitedHealth, which reported $287 billion in revenue that same year. With such relatively minor penalties, insurers are likely to see such fines as part of the cost of doing business.
I don’t know how to solve this systemic and deeply entrenched problem. Perhaps the solution is a single-payer system, as most other developed nations already have. Or perhaps there’s a free market solution, one that eliminates insurance companies (middle-men that they are) and empowers patients and providers.
But as long as insurance companies are incentivized to deny care, patients will continue to suffer.
In the end, I left my six figure job as a Clinical Director and started my own private practice.
I was burnt out on dealing with insurance companies, and I made a firm decision to remain out of network in my own practice.
In order to accommodate at least some clients who couldn’t afford my full fee, I opened up 10% of the “slots” in my practice on a sliding scale basis for lower income clients.
It’s not perfect, but it’s allowed me to serve clients with a wide range of income levels, while still earning a decent living as a therapist–and without having to deal with amoral, and in some cases criminal insurance companies.
My solution has worked for me and my clients. But what about the millions of people who still depend on their insurance to access mental health care? Until we change the structure of our healthcare system, their lives will be at risk.
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Thanks,
Chris
