Lawmakers are taking aim at a common problem for Illinois residents who seek mental health care — many therapists don’t take private insurance.
In Illinois and across the country, a number of therapists have stopped accepting private insurance, saying health insurers don’t reimburse them enough money for their services and force them to jump through too many hoops to give patients the care they need. That can leave patients in a bind, forcing them to choose between paying out-of-pocket for care, waiting for care from a therapist who will take their insurance, or sometimes forgoing help altogether.
A bill sponsored by Rep. Lindsey LaPointe, D-Chicago, seeks to address some of the barriers that therapists say keep them from taking private insurance. The bill would require private insurers to pay in-network therapists at least 141% of the rate Medicare pays for the same behavioral health or substance use disorder service.
It also aims to cut red tape for therapists. The bill would prohibit insurers from requiring therapists to submit more documentation to get reimbursed for 60-minute sessions as compared with shorter sessions, and prohibit insurers from denying coverage for multiple behavioral health services or substance use disorder services for the same patient in one day.
It would also require insurers to cover services provided by therapists in training who are being supervised by licensed professionals, and, when a therapist applies to be in-network with an insurer, the insurer would have no more than 60 days to complete the contracting process with the therapist.
The bill would only apply to health insurance plans regulated by the state. Insurance plans offered by many large employers are regulated by the federal government, not the state.
“The ultimate goal is for people to be able to use the insurance they already pay for to access regular behavioral health like therapy and psychiatric appointments,” LaPointe said. They’re not able to do that now because providers won’t join networks because they’re not getting reimbursed enough.”
The bill passed out of the House with a vote of 72-33 and is now in the Senate. The legislative session ends May 31.
The bill, however, faces opposition from insurance industry representatives. The costs of larger reimbursements to therapists could potentially be passed along to consumers, in the form of higher monthly premiums or higher out-of-pocket costs as patients work to meet their deductibles, said Laura Minzer, president of the Illinois Life and Health Insurance Council, which represents health and life insurers.
Minzer also worries about the potential precedent of lawmakers setting reimbursement rates from private insurers for health care.
“It does create sort of a Pandora’s box where we could see other types of providers coming for the same types of considerations in statute,” Minzer said.
She said protections are already in place to make sure therapists are reimbursed fairly, including state and federal parity laws that require insurance companies to cover behavioral health and physical health care equitably. Each year, insurers have to submit to the Illinois Department of Insurance documentation showing that the processes they use to set reimbursement rates for mental health care aren’t any more stringent than those used for other medical care.
It’s also possible that higher reimbursement rates wouldn’t make much of a difference when it comes to persuading more therapists to accept insurance, Minzer said. Some therapists don’t accept insurance because they’re part of small or solo practices that don’t have the bandwidth for the paperwork, she said.
“I’m not sure that increasing rates and requiring reimbursement to be higher is necessarily going to change the dynamic for some sole practitioners who just don’t want to deal with insurance,” Minzer said.
The Council, however, supports many other parts of the bill, outside of the reimbursement provisions, Minzer said.
“It will go a long way to improving the consumer experience as well as addressing some concerns the behavioral health providers have noted,” she said of other parts of the bill.
Blue Cross and Blue Shield of Illinois, which is the largest health insurer in the state, has also said it opposes the bill, though a spokesperson for Blue Cross declined to comment on the issue for this article.
Those behind the bill, however, say the reimbursement provisions are key.
“If you want behavioral health access you have to increase reimbursement rates … and you have to decrease the administrative burdens or the red tape,” LaPointe said.
Some therapists have not seen an increase in insurance reimbursement rates for more than a decade, said Heather O’Donnell, senior vice president of public policy at Thresholds, which serves people with mental health and substance use disorders in Illinois.
Thresholds has been a driving force behind the bill even though most of its patients are on Medicaid, meaning Thresholds might not benefit much from the measure. Increasing access to mental health care in general is important to the organization, O’Donnell said.
“It’s just time private insurance steps to the plate,” O’Donnell said. “In the end, it’s the people seeking care that get the short end of the stick. They’re paying for insurance, but when it comes to needing to see a therapist, it’s incredibly difficult, so oftentimes they have to go out of network and pay out-of-pocket.”
Jennifer Froemel, who owns private practice Innovative Counseling Partners, is concerned about the insurance industry’s opposition to the bill. Though her practice accepts private insurance, she said her reimbursements have changed little in the last 26 years — in at least one case rising by only about $10 per session in that time frame.
“I really feel like right now we are in such a mental health crisis still that we really need to push for equitable pay,” said Froemel, who also serves on an Illinois Counseling Association task force that examines insurance trends in mental health. Higher reimbursement rates would mean more access for patients, she said.
Lawmakers considered a similar bill last year, but that bill failed to pass by the end of the legislature. LaPointe said the bill simply “ran out of time” last year, but this year, “Our colleagues in the House and Senate are much more aware of the bill this year and truly understand it.”
