Working at a psychiatric hospital during the 2010’s was a wake up call for me. I remember wanting to set up service for an individual but was unable to do so because of their insurance. You would think as long as someone has insurance they’re covered right…but I was sadly mistaken. This insurance challenge is no stranger to people in the mental health field. Which leads to more frustration and confusing when a clinical teams discuss next steps for ongoing care.
This helps with the stigma of mental health. When it becomes a circle to receive services, individuals walk away, leaving a lot of unanswered questions and treatment on the table. The lack of insurance coverage is also the reason many clinicians move to private pay. When you have private pay participants you no longer have to deal with the burden of insurance carriers, denied claims, or the delay of receiving payment for your services.
For services like Psychiatric Rehabilitation Programs (PRP), commercial insurance do not consider these programs as a medical necessity. They do not believe these kinds of programs are beneficial and believes there are less expensive programs for their insurers. How can they determine what is best for someone’s care, especially if they are only reading their case from a piece of paper? Due to this, families are pushed to switch to Medicaid which allows individuals to receive services that commercial insurance would not think twice about paying.
Many family members prefer for their children to be on their plan because overall it makes sense. When you are already paying for a family plan, why complicate things and file paperwork to receive state insurance? This puts families in a bind especially when they know their loved one will not get the same care because oftentimes it’s rare a practice will see people who have medicaid and commercial insurance within the same practice. It’s either you see individuals with state insurance or those with commercial coverage. A change in services can hinder the individuals treatment causing more disruptions in their care.
Insurance companies collectively is projected to make over 450 billion dollars this year, 2025 alone, and the fact that people are struggling to receive mental health care is absorb. There is a lack in this system when it comes to mental health and wellness. People are living in times where their emotional wellbeing is on thin ice. The uncertainty of this country can lead anyone’s mind in shambles, the cost of groceries is rising and certain political parties continue to turn a blind eye. We are in dire need in this country and mental health challenges will be on the rise, if they are not already.
It’s disheartening to know the billion dollar insurance companies gladly take payments from working families, leaving them with little or not support when it comes to their mental health and wellbeing. There needs to be a stand in this and we have to find away to close that gap on care.