The number of people with symptoms of depression and anxiety has almost quadrupled during the Covid pandemicwhich made it even more unbearable to receive timely psychiatric care, even if you are well insured.
A California Law signed on October 8 by Governor Gavin Newsom could help. It requires that patients with mental health and substance abuse be offered return appointments no later than 10 days after a previous session, unless their doctor agrees to less frequent visits.
The current insurance regulations already stipulate that patients have to undergo an initial psychiatric examination at the earliest 10 days after their application. But so far there was nothing in the books specifically about follow-up care.
The law won’t go into effect until July, which lawmakers say will give health plans time to adhere to – mostly through hiring or contracting more therapists. Proponents say that if effectively enforced, the new law will help many people get the care they need.
The law, SB 221, “will ensure that people can actually use their insurance to receive mental health care,” says Senator Scott Wiener (D-San Francisco), the author of the law. “For far too long, health plans have often made people wait long times to get mental health appointments, which undermines their care.”
If you are not getting the care you need, there are already ways to remedy the situation. When the law goes into effect in eight months, it will strengthen your hand. More on that in a moment.
There are two competing explanations for why it is so difficult to receive consistent mental health care. Insurers say there is a lack of therapists. Therapists say insurers are too cheap to pay properly. Many therapists refuse to join insurance networks and set their own fees, which many people cannot afford.
The National Union of Healthcare Workers, which supported the law, particularly criticized Kaiser Permanente, the state’s largest commercial health insurer, for its well-publicized shortcomings in mental health care.
Kaiser Permanente, with over 9 million members in California, was Fine of $ 4 million by state regulators in 2013 for lack of timely mental health care. It was quoted twice afterwards because the problems were not resolved.
Past and current KP therapists say the managed care giant addressed the complaint by trying to ensure members seeking mental treatment get an initial appointment quickly. But that only made it harder for these patients to get more sessions, the therapists say.
“Any available appointment would be given to someone who needs to initiate services,” said Susan Whitney, a marriage and family therapist who worked for Kaiser Permanente in Bakersfield for 18 years before leaving the organization in September. “Our diaries were fully booked for six to eight weeks – so follow-up appointments were difficult to arrange, to say the least.”
The American Psychological Association recommends weekly therapy for people with depression and twice a week for post-traumatic stress disorder. In one Letter To the California Department of Managed Health Care last year, the association said the long wait times for follow-up care reported by KP patients and therapists “are well below what is appropriate for most patients.”
Due to the lack of available therapists, Kaiser Permanente often refers its members to an external network of providers of psychological treatment. However, members, therapists, and officials say these networks often fail to deliver.
Maya Polon, a Communist Party member in Sacramento, felt emotionally frayed in March after caring for her terminally ill grandmother. She tried to get help through Kaiser, but made numerous phone calls and kept receiving conflicting information about how to get care.
Finally, after more than a month, a Kaiser Permanente therapist told Polon, 27, that her depression, anxiety, and panic attacks qualified her for a year of therapy. But if she wanted to do it through Kaiser, it would be six months before she got her first appointment.
KP referred her to an outside mental health service provider, Beacon Health Options, who took two weeks to send her a list of therapists. She called all 20 vendors on the list during work breaks and left messages.
“As someone with anxiety and depression, it’s an overwhelmingly depressing process to actively sit down and call people who keep saying, ‘Oh, I’m not really taking in new patients,'” says Polon. “I’ve said goodbye to this thought: ‘Do I even want to have therapy if I have to go through this to get there?'”
In the end, she saw the only therapist who had room for her, but she didn’t have a contract with Beacon. Polon had to argue with Kaiser Permanente over the paperwork for months.
In June, San Diego City Attorney Mara Elliott, sued Kaiser on what she termed “ghost networks” which “falsely describe the breadth of an insurer’s network of providers and promise consumers access to health care that is in fact not available under the plan”. Elliott is suing Molina healthcare and Health network for similar reasons.
Dr. Yener Balan, vice president of Behavioral Health and Specialty Services at Kaiser Permanente in Northern California, says the organization could do better, but claims it complies with its psychiatrists’ recommendations for follow-up appointments 84% of the time – a number given by union officials and therapists hotly contested.
Balan says the July launch date of SB 221 is helpful “given the shortage of mental health clinicians that all health organizations are facing”.
Health insurance critics doubt that the lack of therapists is the main problem. Wiener says health plans don’t pay psychotherapists enough to join their networks.
A 2019 report by the California Future Health Workforce Commission predicts that within a decade there will be 41% fewer psychiatrists than necessary and 11% fewer psychologists, marriage and family therapists, and other mental health professionals.
But a report That same year, the state Legislative Analyst’s Office said the number of graduates from mental health programs had increased significantly – although there was, it reported, a shortage of psychiatrists.
The Department of Managed Health Care, which regulates health plans for a large majority of Californians, will monitor compliance with the new law and investigate consumer complaints, says Rachel Arrezola, a spokeswoman for the agency.
What you can do
If you think your health plan is falling short on mental health management, then you don’t have to wait for the new law. You can dispute your insurer according to existing regulations. However, once the law goes into effect, it will provide additional baggage for any challenges and allow regulators to pursue health plans for violations.
To dispute a lack of insurance coverage, you must first contact your health insurance company directly. If you have a private plan, you must file an objection within six months of the care being refused. The insurer must decide on your objection within 30 days.
If you do not get a satisfactory decision, take your case to the agency that regulates your insurer for independent review. And if there is an acute health risk, there is no need to wait 30 days. Contact your regulator immediately.
To find out which agency this is, call your health plan customer service. If it’s the Department of Managed Health Care, you can request an independent review by calling 888-466-2219 or signing in to HealthHelp.ca.gov. If your regulator is the California Department of Insurance, call 800-927-4357.
If you are in managed care medicine and your plan is governed by the managed health care department, you can ask that department for an independent review. You can also, like any Medi-Cal beneficiary, request a “fair hearing” by the state by leaving on-line or by phone at 855-795-0634.
Of course, all of this takes time and effort. But if the delay makes treatment impossible, it can be worth it.
KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism on health topics. Along with Policy Analysis and Polling, KHN is one of the three main operational programs at KFF (Kaiser Family Foundation). KFF is a non-profit foundation that provides the country with information on health issues.
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Reference: khn.org
