One of the new requirements of the Affordable Care Act (ACA, or “Obamacare”) is that all new small group and individual market health insurance plans cover mental health and substance use disorder services at a rate equivalent to medical and surgical benefits. That’s good news for people whose plans used to exclude that coverage, or for anybody whose mental health problems were deemed a pre-existing condition that denied them coverage.
Pre-existing exclusions no longer are permissible under the ACA, but that doesn’t mean people in need of mental health care are necessarily out of the woods. As reported by Reuters.com, U.S. psychiatrists are less likely to accept insurance than doctors in other specialties.
That’s the conclusion of a recent study in the journal JAMA Psychiatry.
Researchers, led by Dr. Tara Bishop at Weill Cornell Medical College in New York, found that only about half of psychiatrists accepted private insurance between 2009 and 2010; almost 9 in 10 doctors in other specialties accepted insurance.
Bishop’s team reported that there is professional concern over the limited access to mental health services because psychiatrists refuse to accept insurance. “It’s certainly something that I have to think about on a regular basis – about which doctors take insurance and which ones can see my patients,” Bishop told Reuters.
The study analyzed data collected by the U.S. government between 2005 and 2010. About 1,250 doctors were surveyed every year and about 6 in 100 were psychiatrists.
Not only was the proportion of psychiatrists who accepted private insurance lower than other types of doctors, it decreased during the study period. About 7 in 10 psychiatrists accepted private insurance in 2005 and 2006, but only 5.5 in 10 in 2009 and 2010.
The proportion of doctors in other specialties accepting private insurance also decreased during the study period, but not as much. A bit more than 9 in 10 doctors other than psychiatrists accepted private insurance in 2005 and 2006, and slightly less than 9 in 10 did so in 2009 and 2010.
The proportion of psychiatrists who accepted Medicare and Medicaid also was lower than other doctors. In 2009 and 2010, 5.5 in 10 psychiatrists accepted Medicare and a bit more than 4 in 10 accepted Medicaid. Among other specialists, more than 8 in 10 accepted Medicare and more than 7 in 10 accepted Medicaid.
Why psychiatrists seem less willing to accept insurance than other practitioners is a matter of speculation. Insurance might not pay psychiatrists enough for the time they spend with their patients compared to the time a family doctor spends. There might be a shortage of psychiatrists, so there are more patients willing to pay to be seen.
Dr. Jeffrey Lieberman, president of the American Psychiatric Association, told Reuters that reimbursement is a huge obstacle for psychiatrists to accept insurance.
“Many doctors can’t afford to accept insurance because [insurance companies] don’t pay them for the time,” he said. “It involves taking more time with the patient and often treating them with psychotherapy.”
Lieberman said new regulations to address the disparity in payments for psychiatrists versus other practitioners should help to close the coverage gaps, but the shortage of psychiatrists is another issue.
Lieberman noted that the JAMA study reviewed only office-based psychiatrists, not those working in hospitals or clinics.
If mental health care is important to you or a member of your family, when comparing insurance plans make sure to review each one’s network of psychiatrists and psychologists, and its formulary (the list of medicines it covers, and the level of subsidy for each) for psychotropic drugs (which affect mental activity, behavior or perception). In many cases, it might be worth paying a higher premium for a more generous network for the kind of care you need.
For information on mental health therapists, see our backgrounder.