Behavioral Health
Article

Why is mental health care so hard to find with private insurance?

May 1, 2023
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The Center for Community Solutions recently partnered with the Community Counseling Center of Ashtabula County to examine the behavioral health needs in Ashtabula County. One thing that came up in nearly every conversation we had with community members and stakeholders was the difficulty of finding behavioral health providers who accepted private insurance. Our community survey results supported what we were hearing.  

Thirty-eight percent of survey respondents had private insurance either through their employer or purchased on the marketplace. Of those, 43% have been diagnosed with a mental health disorder and 2 percent with a substance use disorder. Less than 30% of those with private insurance indicated they would be able to find a behavioral health provider when they needed one. In an open-ended question that asked about behavioral health services missing from the community, multiple individuals with private insurance identified the need for more providers who accept their insurance, whereas those with public insurance did not identify this as a need.

 Less than 30% of those with private insurance indicated they would be able to find a behavioral health provider when they needed one.

While our research was specific to Ashtabula County, challenges to accessing mental health care with private insurance appear to be more widespread. A study recently released by Kaiser Family Foundation on Women’s Health found that one-fifth of privately insured women with mental health appointments in the past two years say their provider did not accept their insurance. More than a third of the women in the study had to wait more than a month to for a mental health appointment and cited limited provider availability as a reason for the long wait times. The study also found that women covered by Medicaid sought mental health care at a rate higher than their privately insured peers. It is unclear if Medicaid enrollees have a higher need for care or seek care because they know providers will be available to them.  

The inability to find a provider who accepts private insurance has many causes including workforce shortages and the mismatch between supply and demand among mental health care providers.

 Women covered by Medicaid sought mental health care at a rate higher than their privately insured peers.

The Health Resources and Services Administration (HRSA) identifies health professional shortage areas (HPSA) for defined geographic areas for mental health providers. Most counties in Ohio have a shortage with the number of full-time employees needed to fill the gap ranging from 1.27 to 6.85.  

 

A 2018 report from HRSA projected behavioral health care provider shortages for the year 2030 with detailed projections for specific behavioral health professions. The study projected future needs based on the current met and unmet need when determining how many professionals would be needed to in the year 2030 to meet all the needs. For the state of Ohio, it is projected there will be shortages in psychiatry, adult psychiatry, psychiatric physician assistants, clinical, counseling and school psychologists, addiction counselors, mental health counselors and marriage and family therapist.  

Source: State-Level Projects of Supply and Demand for Behavioral Health Occupations: 2016-2020  

Even when a provider who accepts insurance is available, receiving the appropriate level of treatment is not a given. NPR recently reported on the topic and featured a family from Columbus who spent years searching for mental health care covered by their private insurance for their daughter. They eventually found the specialized mental health treatment she needed in Wisconsin only to have the private health insurer deny the claim mid-way through her course of treatment for reasons related to cost as opposed to treatment needs. The Mental Health Parity and Addiction Equity Act of 2008 aims to prevent annual or lifetime limits on behavioral health care that are more restrictive than medical or surgical benefits, it however has many exceptions and is not always enforced.  

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