Depression and Bipolar Support Alliance
“Worsening of symptoms,” “inability to work,” “hope for the best,” “stretch my medication” are a few of the reported consequences people face when they are unable to obtain an appointment with a psychiatrist. These responses and others like it come from a survey conducted by the Depression and Bipolar Support Alliance (DBSA) that revealed the challenges people face when their health insurance plans lack an adequate number of in-network psychiatrists. The short survey revealed that 38% of respondents were not able to make an appointment with an in-network psychiatrist and 40% believed the wait time between seeking an appointment with a psychiatrist and being seen was too long.
A mental health parity issue
DBSA and other mental health organizations have taken on this concern as a mental health parity issue. One of their goals is to advocate for solutions by identifying and defining the problem. Building on what was learned from the previous survey, DBSA is seeking more insight into the lengths individuals and families go to obtain care. To that end, we invite everyone to take our Access to Psychiatrist survey.
The survey inquires:
- how many doctors an individual had to call before obtaining an appointment
- how many contact attempts failed because the plan provided incorrect contact information
- how many weeks went by between commencing the search and the first appointment
- whether or not the location of the doctor is geographically convenient
- if there was a delay in obtaining care, what were the consequences.
Joining DBSA in its efforts to address parity issues is the American Psychiatric Association (APA) which recently conducted a secret shopper survey of the three largest health insurance carriers in Washington, DC. The study found that 85% of the psychiatrists listed in the provider directories were either not reachable or not able to schedule a new outpatient mental health visit within seven days. The survey also found that 23% of the phone numbers listed in the directory were either non-working or non-responsive and only 48% of the psychiatrists were practicing at the listed phone number. For the 15% of callers who were able to schedule a new outpatient appointment, the average wait time was nearly three weeks. Other surveys show that the situation is similar for all mental health professionals.
The APA survey shows that provider directories are inaccurate, the networks do not have enough practitioners available to adequately care for patients who need their help and patients are left with the unfortunate choice of going without needed care or paying out of pocket for care. This essentially shifts costs from the plans to the patients, who have already paid premiums to get access to this care and now must pay for it out of pocket. APA is working with the Attorney Generals around the country to bring attention to the problem of deceptive provider directories.
Role of state regulatory insurance agencies
Whether you advocate for mental health parity or you just want to address your own situation, getting to know the personnel at your state’s insurance regulatory agency can be helpful. For example, during a meeting with the Illinois Department of Insurance (IDOI), DBSA learned
- the IDOI reviews all networks for adequacy in compliance with the department’s own checklist and criteria
- the IDOI believes narrower networks can potentially limit consumers’ access to care—including mental health care
- the IDOI wants to hear from plan beneficiaries! If you live in Illinois and you believe your insurance plan does not provide adequate access to mental health clinicians, the IDOI asks that you file a complaint at this link. (For people in the other 49 states, ParityTrack, the collaborative working toward parity implementation at the state level, has a wealth of tools to assist you in filing a complaint.)
Consequences of narrow provider networks
What happens when people are unable to secure an appointment with a psychiatrist? The DBSA survey included an open-ended question to let us know what happens. The number one response: sought services at an emergency department. The second highest response: needed to be hospitalized. Neither of these is a good solution for treatable mental health conditions.
Admittedly, it is difficult to substantiate the hard costs associated with lack of access to care. However one only need look at the affect closing city mental health centers had on the health system in Chicago, Illinois. Emergency rooms visits for people in psychiatric or behavioral health crisis spiked by 19%, costing the state $131M in increased hospitalizations and admittance to mental health facilities. As we look for ways to control health care costs and improve care, solving the network adequacy problem should be a number one priority.
When you share your experience in the DBSA Access to Psychiatrist survey, you’ll be helping the community of advocates to better identify and define the extent of the provider network problem. With this knowledge, all of the stakeholders can work together to identify solutions.
- What do you think can be done to increase the availability of psychiatrists through health insurance?