Last updated 8/7/2023
Here’s a simple question: Does your medical insurance cover mental health conditions? The answer is probably yes. How about this one: If you’re experiencing anxiety, depression, or some other mental health problem, will you be able to access care?
If you have coverage, the answer should also be a simple yes, but if you’re like most Americans, it’s not simple at all.
When people call psychiatrists who are listed as participating providers in their insurance plans, they often get disconnected numbers, messages that the doctors are no longer accepting new patients, or a confused receptionist trying to explain that the doctor does not, in fact, accept insurance.
In many cases, it’s simply not possible to get an appointment with a participating provider, and people give up, even though they need care for potentially very serious mental health symptoms. What’s going on? If there are dozens of psychiatrists in my community listed on my insurance company's website, why can’t I get a single appointment?
The answer is that the list of psychiatrists your insurance company gave you may be a “ghost network.” That means that most of them, maybe even all of them, aren’t really available to you.
There’s a psychiatrist shortage in the United States. The population is growing, while the supply of psychiatrists is getting smaller. Between 2003 and 2013, the number of practicing psychiatrists shrunk by 10%—and it continues to do so.
This is in the context of not only a growing population, but also a larger prevalence of mental illness within the population. The rate of past-year depression, for instance, grew by 26% between 2015 and 2020. Due to an increased need, as well as other factors, in 2009 more than 90% of U.S. counties had a shortage of mental health professionals.
Assuming you’re able to find psychiatrists in your area, it doesn’t mean they’ll take your insurance. In my experience, insurance companies don’t treat psychiatrists well. Often psychiatric care is reimbursed at a lower rate than other medical specialties.
Psychiatrists must justify the treatment they give with burdensome pre-authorization requirements. They must persuade the insurance company that the care they propose is medically necessary.
As a psychiatrist myself, I understand how filling out these forms requires hours of tedious work, back-and-forth phone calls, etc. In many cases, the insurance company simply refuses to cover the proposed treatment (e.g. psychotherapy, prescribed medications, etc.).
You can guess what the result is. Psychiatrists are voting with their feet—they’re walking away from being participating providers with insurance companies. In fact, fewer psychiatrists are willing to accept patients who wish to use insurance when compared to other specialists: 55% vs. 89%. Almost half of American psychiatrists accept no insurance at all.
Professional organizations, such as the American Psychiatric Association, have tried working with insurance companies to include more psychiatrists on their provider panels, but success has been elusive. Instead, insurance companies are merely promising their subscribers access to mental health care, but they’re not delivering it.
The situation has become so serious that in May of this year, the United States Senate held a hearing on the problem of ghost networks.
A secret shopper study was conducted in which staffers from Senator Ron Wyden’s office attempted to make appointments with mental health providers listed in health plans’ directories. They found that more than 80% of listings were either inaccurate or the provider was no longer available. In some states, like Oregon, it was 100%. Not a single mental health provider listed in the directory was available for an appointment.
There’s no single, magic solution to this problem. We need to understand why the supply of psychiatrists is shrinking; why older psychiatrists are leaving the profession (for example, 60% of psychiatrists are over 55 and may be retiring), and why medical students have been choosing other specialties—although the past few years have seen an increase in psychiatry residents. We also need to develop innovative ways of delivering care to those who need it.
Telemedicine companies, like Hims & Hers, have developed new technologies to make mental health care more affordable and accessible. Telepsychiatry allows providers to deliver care more conveniently and quickly than is possible in traditional settings.
A recent study found that the median wait time for a new patient to see a psychiatrist in person (if you’re able to find one) was 67 days. The wait time for a telepsychiatry appointment (via telephone or video conferencing) was 43 days. That’s an improvement, but it’s still too long.
Hims & Hers has developed a unique way for people to access affordable treatment 100% online, and those who are appropriate for this service are able to start treatment quickly, with a response from a licensed provider in 48 hours or less. And no insurance is necessary.
Mental illnesses cause untold suffering, not only for patients but also for their loved ones. They interfere with a person’s relationships, their ability to work, and their ability to enjoy life. Although these illnesses are a growing problem in the United States, the supply of psychiatrists is dwindling.
Insurance companies make the problem worse by driving psychiatrists away with poor reimbursement and heavy administrative burdens. Instead of looking for ways to fix this problem, they sweep it under the rug with ghost networks that give a false sense of hope to their subscribers who need mental health care.
It may be that the traditional mental health system needs to evolve into something that does a better job of meeting the needs of patients. New technologies that allow patients to access care quickly, conveniently, and affordably will be part of the solution. Other parts may be increasing residency slots and training even more residents and improving reimbursement for psychiatric care.