Health insurance no guarantee to mental health access and affordability

In the best of Oklahoma commercial health insurance plans, only 30% of the state’s behavioral health providers are included. In-network providers are so scarce that patients often wait months to get an appointment; a time that can escalate symptoms.

Once a provider is located, insurance plans continue to pay less for mental health than other health care needs.

Anyone who has navigated the behavioral health system in Oklahoma knows this. Parents have social media groups dedicated to finding tricks and tips for getting children into care. Adults rely on word-of-mouth referrals.

My experience trying to find mental health care for insured family members led to more than 25 calls and a three-month wait to the one provider who had an opening. Only if a person is suicidal or violent would access have been faster.

Up until now, this chaotic web of nonsense has been anecdotal. The public policy focus has been on low-income families qualifying for SoonerCare or other government programs.

Now, the Healthy Minds Policy Initiative has data to support all the frustrations with private insurers.

Every state elected official, policy maker and health provider ought to take a look at the findings. We can surely come up with a better way to serve Oklahomans, who rank among the nation’s most in need of mental health services.

In a test of calling behavioral health providers in directories provided by private insurers, about 65% of those listed could not be reached; half of those had disconnected or out-of-service numbers. These were calls to 159 providers in nine urban, suburban and rural ZIP codes.

Of the 56 providers reached by phone, 40 agreed to interviews. Of those 40.18% were found not to be in the insurer’s network or didn’t know if they were in the network.

Only 60% of 40 providers interviewed could provide information on a wait time for an appointment; 33% offered an appointment within a month; and 18% had an opening with a week. The standard for outpatient care after initial contact is seven days.

At least 90% of Oklahomans live within 30 miles of a behavioral health provider, but fewer have a psychiatrist or substance abuse treatment specialist that close. Depending on the insurance plan, as few as 64% live within 30 miles of a substance abuse specialist, and 71% have a psychiatrist nearby.

When matching available behavioral health providers to those listed in insurance directories, only 30% are in network. Any given directory leaves between 63% and 71% of licensed psychiatrists, and at least 66% of licensed substance use treatment specialists are missing.

In Oklahoma, private insurance pays on average 30% less for behavioral health providers than for general health care practitioners.

When a person starts experiencing mental health symptoms, it can escalate to tragic and expensive situations, including self-harm, suicide or harming others. It can lead to criminal justice involvement, missed work or school days, and damaged relationships.

The cost of treatment goes up as people reach higher levels of need.

Also, this is a workforce issue, especially as employers are often the purchasers of insurance plans on behalf of workers. Poor behavioral health networks affect the bottom line. Untreated depression costs an average of 31 days of lost productivity per employee, and employers lose nearly $200 billion annually in potential earnings as a result of untreated mental illness, the report states.

At this point, Oklahoma is pretty far from investing in prevention.

The state is No. 6 in the US for suicide deaths, according to the United Health Foundation using 2020 data, the latest available for all states. It shows Oklahoma reaching its highest rate since at least 2009.

Last year’s Kids Count Data Book showed that 1 in 8 Oklahoma children between ages 3 and 17 had anxiety or depression in 2020, up 15% from 2016. America’s School Mental Health Report Card last year found that of 54,000 Oklahoma children with major depression, about 30,000 are not receiving any treatment.

Small steps are being made to get a handle on this.

Last year, lawmakers put $300 million in federal American Rescue Plan Act funding toward mental health and launched 988 as part of the new national mental health helpline. House Bill 4106 established partnerships between school districts and community mental health providers to respond to students in crisis.

Two pending proposals would address some issues brought up in the Healthy Minds report.

Senate Bill 254 — sponsored by Sen. Jessica Garvin, R-Duncan, with co-sponsor Rep. Jeff Boatman, R-Tulsa — would allow insured people to seek out-of-network mental health care coverage at no additional cost when the networks fail them.

Senate Bill 442 — introduced by Sen. John Michael Montgomery, R-Lawton, with Rep. Chris Sneed, R-Fort Gibson — would outline standards for directory accuracy and reporting requirements. More than half of states have similar standards.

No rational policy maker would develop a health care system this way. The onus is on the patient — or usually a family member or caregiver when it comes to mental health — to find and access care.