Who's Providing?

If you’re looking for a mental health therapist, odds are that you may have a hard time finding one in your private insurance network. This is mostly because the mental health field faces workforce shortages, low reimbursement, and high demand for services. About 35% of psychiatrists do not participate in managed care networks compared to 12% of other specialists. This lack of accessible providers has resulted in higher rates for out-of-network mental health care, as well as higher out-of-pocket spending for patients.

Patients often have long-term relationships with their primary care provider and may be more comfortable getting mental health care from that provider. Seeing a primary care doctor is also advantageous cost-wise, since insurance already covers that care. A study led by Susan Busch compared patients’ perceptions of the adequacy of the mental health provider network available under their policy (including psychiatrists, therapists, psychologists, and social workers) with adequacy of their medical provider network (doctors, nurse practitioners, and physician assistants).

As the Figure shows, patients receiving care from a mental health professional within their network (yellow bars) rated their care options as inadequate compared to their medical care provider options (blue bars). For patients who received care from both their mental health and medical provider, there was no significant difference how they rated their network options.

The authors speculate that patients may feel that their mental health plan is inadequate because they experience higher costs and longer wait times because of workforce shortages, and the lack of available, in-network mental health specialists. The burden of mental health care has fallen to primary care providers, at least until more mental health clinicians can be convinced to join insurance pools and make themselves more available at affordable prices.

Databyte via Busch SH, Kyanko K. Assessment of Perceptions of Mental Health vs Medical Health Plan Networks Among US Adults With Private Insurance. JAMA Network Open, 2021.