August 27, 2024

By Courtney Wise

This has created a desolate landscape for patients in search of care, as therapists leave insurer networks in droves, hoping to avoid roadblocks to proper patient care and to earn their livelihoods.

In other news, Michigan uses opioid settlement funds to provide transportation to people in need of substance use treatment. Homelessness for veterans approaches “functional zero” in Minnesota. And what six unlikely friend groups have to say about the benefits of intergenerational friendship. Plus: How a father “dramatically” improved his life by putting down his cell phone.

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Here’s why you can’t find a therapist who takes your insurance

Are you having trouble finding a therapist? It’s tough to find one who will take your insurance because so many professionals have left insurance networks. That’s because scores of insurers have put their own financial gain first, making it nearly impossible for mental health providers to deliver the care they know patients need, according to the findings of a ProPublica investigation, co-published with NPR. 

“The way to look at mental health care from an insurance perspective is: I don’t want to attract those people. I am never going to make money on them,” said Ron Howrigon, a consultant who used to manage contracts with providers for major insurers. “One way to get rid of those people or not get them is to not have a great network.” Poor networks, the investigation found, are what patients encounter more and more, as mental health providers say they’re forced out of in-network service.

ProPublica interviewed more than 500 mental health professionals, including psychiatrists, psychologists, and therapists from nearly all 50 states, working in rural, suburban, and urban communities. Their investigation revealed that, with the implicit support of lawmakers who fail to hold insurers to account, insurance companies determine which patients can receive treatment.

Insurance companies can also determine what treatment patients can get, and for how long they can receive it – even when it disagrees with the evidence-based recommendations of experts in mental health care. 

Multiple providers told ProPublica that insurers requested that they alter care plans for patients with severe mental illness and others in crisis, even when at risk of suicide. “I felt all this pressure to say the right thing to be able to keep giving my client what she needed,” said Melissa Todd, an Oregon-based psychologist who was pressured by UnitedHealthcare to terminate therapy services for a patient facing an unpredictable, potentially life-threatening mental crisis.

Moreover, when care plans aren’t challenged, insurers take so long to issue meager reimbursements that they threaten professionals’ livelihoods, so they are constantly gambling with their ability to keep their practices open.

“With problematic insurers, it takes three, four or five months to get paid, and it’s costing me as a business,” said Marsinah Ramirez Buchan, a therapist in Bakersfield, California who ended her relationship with networks last year. “I see clients for eight hours and then I spend four hours on the phone with insurers.” 

Shaina Helm, a therapist in Chicago, left because she needed a second job to make ends meet. And Lisa Hanson, a therapist who once worked as a manager in behavioral health at Cigna told ProPublica that part of the problem experienced by providers trying to get claims paid is from the outsourcing of customer service to countries overseas where employees have only partial access to claims systems and are unfamiliar with complex medical terminology in English. It’s not by accident, she added.

“The idea is if you make it so frustrating for providers to follow up on claim denials, they’re just going to give up and the insurance company is not going to have to pay out,” Hanson said.

The issue exacerbates a pre-existing problem: the national shortage of therapists in the first place. With even fewer numbers of mental health providers in insurance networks to serve people looking for care, nearly half of Americans with mental illness are left without access to treatment—even though roughly 90 percent of citizens have health insurance. 

In response, insurers told ProPublica that their policies are in compliance with state and federal laws, their provider reimbursement rates match market value, and their intent is to ensure patient access to mental health providers, who they routinely recruit.

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SUVs are the latest addition to the opioid crisis toolkit in Michigan

Addiction treatment is only effective if one can get to it, so a ride to treatment is the latest tool that addiction service providers have added to their resources for people battling substance use disorder in Michigan. The state awarded $2.7 million to 20 addiction service providers in 15 counties for transportation, Bridge Michigan reports, with plans to add another $2.5 million in next fiscal year’s budget. The transportation grants are funded by nearly $800 million in opioid settlement money the State of Michigan will receive over the next 18 years.

“If you don’t have the means to get to your appointment, if you don’t have the means to get your methadone or to get the resources you need, then that is a huge obstacle,” said Natasha Bagdasarian, chief medical executive for the state.

Greg Toutant, executive director of Great Lakes Recovery Centers in the state’s largely rural Upper Peninsula, was more blunt: “Every facet of care is connected to transportation; it’s literally keeping people alive.” Some people travel 100 miles per day in the region to get their daily required dose of methadone, one clinic supervisor said. 

The grants provided 4,100 rides in the first quarter of the year, the state reported.

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Homelessness approaching “functional zero” for veterans in Minnesota

The State of Minnesota is on track to join Connecticut, Delaware, and Virginia as the fourth state to end homelessness for veterans. Officials expect to reach their goal of “functional zero” in late 2025, they told Pioneer Press. The designation indicates that some veteran homelessness may still occur, but that the system at work to prevent homelessness works so well, those instances are rare and brief.

State government and agency leaders across Minnesota have worked diligently over the past 14 years to reduce the number of homeless veterans from 644 in 2010, to 336 in 2023, to under 200 as of June 2024. “One of the big roles we took as an agency was the responsibility of pulling everybody together — the federal VA, us, all those stakeholders, all those homeless providers — and coordinating it,” said Brad Lindsay, commissioner of the Minnesota Department of Veterans Affairs (MDVA).

That effort included building a registry that named every veteran facing homelessness. The database makes it easier to connect people to the relevant organizations and care workers that could get them started on an individualized housing plan.

In addition, with the lack of affordable and available housing noted as one major barrier to keeping veterans off the streets, the MDVA developed the Veteran Temporary Emergency Housing Assistance Program, providing financial support for veterans to cover a hotel or other temporary housing while on the path to a permanent home. The agency also offers landlords financial incentives to create veteran-specific housing. 

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In other news…

What’s the best diet? There’s vegan, Paleo, Keto, old-school omnivore, Mediterranean, and more, all followed by people seeking to lose weight or achieve optimal physical health. But, Arthur Brooks asks in his latest for The Atlantic, which diet makes us happiest? The answer, his journey reveals, isn’t so much what we eat – but how and who we eat with.

Congresswoman Yadira Caraveo announced on Monday that she’s seeking treatment for depression at Walter Reed Medical Center in Washington DC. The Democrat representing Colorado’s 8th House District was elected in 2022 and is the first Latina federal representative from the state. KDVR-TV reports that she made news of her treatment public to help destigmatize the issue and encourage others who need help to get it. “It is my hope that the millions of people who struggle with depression, post-traumatic stress, anxiety or any other mental health issues seek help,” Caraveo said in a statement. “I will continue to fight for access to counseling and mental health services so that any American that ever needs it, has access to it.”

The beauty of intergenerational friendship: The Los Angeles Times interviewed half a dozen unexpected but thriving friend groups, all composed of people from different generations. “From both sides there are individual level benefits that have the potential to improve health and well-being,” said Lauren Dunning, director of the future of aging at the Milken Institute. Early research in the new area of study concludes that older adults who regularly interact with younger people experience less anxiety, depression and reduced cognitive decline than their peers with friends all of similar age. Children and young adults in healthy friendships with older adults seem to demonstrate less internal and external ageism. 

Smartphones are ubiquitous, and for many, indispensable. Mark Lukach put his down anyway, in exchange for a “dramatically improved well-being,” he wrote in this guest column for the Washington Post. Unable to fully break from the smartphone due to society’s increasing dependence on mobile digital technologies, he still owns an iPhone, but solely for the moments when he must use it. His primary phone is the classic flip variety, enabling him to connect more with the people around him — at his son’s school during dropoff and pickup, in line at the grocery store, and even at home, asking neighbors for restaurant recommendations rather than searching for options online.

Lukach’s anxiety is reduced, too. “I’m so much more IRL (in real life), finally free of the smog of internet conversation,” he says. “I am slow to get breaking news, and the enraging commentary surrounding it.” Work is less stressful too, now that he’s taken the hum of constant email alerts out of his pocket.

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If you or someone you know is in crisis or experiencing suicidal thoughts, call or text 988 to reach the 988 Suicide & Crisis Lifeline and connect in English or Spanish. If you’re a veteran press 1. If you’re deaf or hard of hearing dial 711, then 988. Services are free and available 24/7.

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