I have written a lot about the debilitating and often accelerating effects of anxiety created by the world we now occupy, as well as generalized anxiety disorder, PTSD and other mental health threats that require acceptance and proper care. According to a survey on mood disorders published recently by the National Alliance on Mental Illness, such public discourse has not only helped elevate these issues to their proper place as a priority, but a large percentage of people are coming around and accepting that mental disorders can happen to anyone.
Once addressed, you would think that finding available professional help when it’s needed would be the least of one’s worries. Both insurers and the medical community know that untreated mental illnesses are closely linked to poorer physical health and societal costs associated with disability and unemployment. As noted in an NPR interview by psychiatrist Ken Duckworth, the National Alliance on Mental Illness’ chief medical officer, with the rise in mental health symptoms during the pandemic, it’s become even more urgent to improve access to care for everybody.
As Duckworth explains to NPR, for many Americans who live with a mood disorder, cost remains a major hurdle to accessing mental health care. More than half of the survey’s respondents, including people living with mood disorders and their caregivers, said that cost prevents them from seeking a treatment. It was also the reason for discontinuing treatment for about a quarter of the respondents who were able to get care.
“Forty-eight percent are unsure if they’re eligible to receive care, and nearly as many are unsure about how to access services,” says Duckworth. The survey also revealed that many people are uncertain of how to even find mental health support. For people with Medicaid or private health insurance, getting access to therapy and other kinds of mental health support is complicated, hard to navigate and expensive. Insurers’ directories for in-network mental health care providers are often not accurate or up-to-date. Even accurate in-network listings for mental health services tend to be small. In addition, reimbursement rates for mental health providers tend to be considerably lower than physical health providers. According to a 2019 analysis by Milliman, a risk management company, this discrepancy continues today.
“What we see all the time is either a plan doesn’t have any out-of-network benefit at all — in which case you’re paying completely out of pocket — or the much higher cost-sharing for the out-of-network provider,” David Lloyd, a senior policy adviser at the mental health advocacy group the Kennedy Forum, explains to NPR. “That can deter families from reaching out to get the help they need.”
This all speaks to a much larger problem. As outlined in a USA Today report, a national survey by the Commonwealth Fund reveals that Americans, if infected with the coronavirus, are increasingly struggling to pay their medical bills due to loss of income or employer health insurance coverage. Lead author Dr. Sara Collins, Commonwealth Fund’s vice president for health care coverage, access and tracking, says: “They suffered ruined credit ratings. They were unable to afford basic life necessities like food, heat or their rent.” She says that this trend is now a chronic problem in the U.S. health system. According to a Credit Karma analysis of nearly 20 million Americans, $45 billion of medical debt in collections were reported.
While many health insurance companies waived co-payments and other cost-sharing requirements for people with COVID-19, “a study by University of Michigan and Boston University researchers found even those with health insurance were hit with medical bills during the pandemic,” writes USA Today’s Taylor Avery.
It is why, since the beginning of the pandemic: “Congress has authorized $186.5 billion for hospitals and other health providers to offset the costs of caring for COVID-19 patients who don’t have insurance. Of that amount, more than $117 billion has been paid to hospitals and other providers.” As explained by Commonwealth Fund officials, federal funding does not cover all costs hospitals incurred taking care of patients. “Hospitals could collect funds only for patients with a primary diagnosis of COVID-19, so patients who sought care for other medical problems were not covered.”
As a recent investigative report by The New York Times reveals, when the
federal government ordered hospitals to begin publishing a complete list of the prices they negotiate with private insurers, the insurers’ trade association called the rule unconstitutional. Four hospital associations jointly sued the government to block it. When they lost their case, they appealed and lost again. This requirement to publish prices represents a rare bipartisan effort of an initiative that began during the Trump administration and found Biden administration support.
According to Times reporters Sarah Kliff and Josh Katz, “many hospitals are simply ignoring the requirement and posting nothing … data from the hospitals that have compiled hints at why the powerful industries wanted this information to remain hidden. It shows hospitals are charging patients wildly different amounts for the same basic services: procedures as simple as an X-ray or a pregnancy test.
“Until now, consumers had no way to know before they got the bill what prices they and their insurers would be paying. Some insurance companies have refused to provide the information when asked by patients and the employers that hired the companies to provide coverage … In many cases, insured patients are getting prices that are higher than they would if they pretended to have no coverage at all.” The trade association for insurers called it “an anomaly” that some insured patients got worse prices than those paying cash.
“It’s not just individual patients who are in the dark,” says Martin Gaynor, a Carnegie Mellon economist who studies health pricing. “Employers are in the dark. Governments are in the dark. It’s just astonishing how deeply ignorant we are about these prices.”
“A growing number of patients have reason to care when their insurer negotiates a bad deal,” says the Times. “More Americans than ever are enrolled in high-deductible plans that leave them responsible for thousands of dollars in costs before coverage kicks in.”