How to get mental health care when insurance doesn't help

An increasing number of people receive mental health treatment, but paying for it is an obstacle, even with insurance.

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Myles Ma, CPFCSenior ReporterMyles Ma, CPFC, is a certified personal finance counselor and former senior reporter at Policygenius, where he covered insurance and personal finance. His expertise has been featured in The Washington Post, PBS, CNBC, CBS News, USA Today, HuffPost, Salon, Inc. Magazine, MarketWatch, and elsewhere.

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An increasing number of people received mental health treatment in 2021, according to new data from the National Center for Health Statistics, including almost a quarter of adults age 18 to 44, an increase of 5% from 2019. But while the use of mental health care has increased, it’s still very difficult to access care using health insurance.

The COVID-19 pandemic brought about a mental health crisis, says J. Wesley Boyd, a professor of psychiatry and medical ethics at Baylor College of Medicine. But the basic problem of accessing mental health care — too few practitioners who accept insurance — hasn’t gotten any better.

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“[Practitioners] can do a hell of a lot better, and make a lot more money, if they don’t take insurance,” he says.

While technology has expanded the number of ways to access mental health care, the high demand for practitioners means they can still afford to charge more than insurance companies are willing to pay.

Is it getting easier to find mental health care?

While accessing mental health care can still be difficult, three things have made it easier during the pandemic: 

  • The explosion of telehealth: Even before video conferencing was a regular part of our lives, employers were spending money to make remote health care services, known as telehealth, available to their employees to reduce the expensive use of emergency rooms. The pandemic made telehealth much more popular for mental health services as well, says Suzanne Delbanco, executive director of Catalyst for Payment Reform, a nonprofit that represents employers that purchase health care and advises them  on how to get the best value out of their health benefit spending. In recent years, the number of services companies have to choose from has exploded. Dozens of mobile apps (you’ve probably heard them advertised on your favorite podcast) that make therapy available via video or text chat have expanded access to care, Delbanco says. Employers have made both apps and telehealth available to employees through their health insurance benefits. 

  • Reduced stigma around mental health care: Employers, and society at large, have become more cognizant of the importance of mental health. Big companies have been more willing to use their influence to pressure health insurance companies to expand access to mental health care as a result, Delbanco says, especially as they recognize the effect on the bottom line: Worldwide, depression and anxiety disorders cost the equivalent of more than $1 trillion in lost productivity each year. [1] The stigma against seeking mental health care has lessened even more during the pandemic. “Stigma was really a problem in the past,” Delbanco says. “It kept a lot of people from wanting to seek care.”

  • Reduced prescription drug prices: While the use of prescription drugs to treat mental health disorders increased from 2013 to 2020, spending on these drugs fell 15%, thanks to generic versions becoming available, says Paul Fronstin, director of the Health Research and Education Program at the Employee Benefit Research Institute. Fronstin co-authored a report, based on insurance claim data, that found the average health insurance enrollee with a mental health diagnosis spent $2,380 a year on mental health services in 2020, up 20% from 2013.

How to save on mental health care

There are a few ways to lower the cost of mental health treatment if insurance won’t cover it: 

  • Negotiate, on price and frequency of services: Many therapists offer services on a sliding scale depending on your financial situation. If your health allows, opting for fewer sessions each month can also save money.

  • Find a community health center: These programs take patients regardless of ability to pay, and many offer mental health services. You can find one near you on the federal Health Resources and Services Administration website. Mental health clinics at nonprofit and even some private hospitals frequently accept insurance, Boyd says, though some might have waiting lists for new patients.

  • Check your local college: Many schools have clinics where you can see a student therapist under the supervision of a professional at an affordable cost. 

  • See what your employer offers: Many people don’t take full advantage of all their employee benefits, Delbanco says. Check with your benefits manager about what they offer in terms of mental health treatment. Aside from traditional talk therapy, common benefits include virtual coaching and therapy, treatment for sleep disorders, and training to deal with stress. If something isn’t available through work, it can help to voice your concerns to the human resource department, either directly if you feel comfortable, or via anonymous employee surveys. Employers aren’t always in touch with their workers’ mental health needs, Delbanco says. “There’s always a gap between the person who sits in the HR office and the employees that are out there,” she says.

Image: Richard Drury / Getty