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In this country, we have a failure to make a connection. Many people have mental health conditions that call for therapy. Many therapists stand ready to help. Insurance companies should bring them together but instead may keep them apart. April Dembosky reports from our member station KQED.
APRIL DEMBOSKY, BYLINE: Michael Klein has been a psychologist in San Francisco for more than 20 years. He considers it his spiritual calling to help people calm their social anxiety and to help couples stop fighting and build trust.
MICHAEL KLEIN: With the right kind of support, they blossom.
DEMBOSKY: Klein doesn't accept insurance. And in fact, a recent survey found that nearly half the therapists in California don't take insurance. Klein says there's two reasons why.
KLEIN: One, because their reimbursement rates don't provide a living wage in the Bay Area.
DEMBOSKY: Most insurance companies pay therapists between $60 and $80 dollars per session. In the Bay Area and Los Angeles, the market rate for therapy is more like $150 or $200 a session.
KLEIN: The second thing is for an hour of psychotherapy, you spend a half hour of paperwork. So, I mean, I got into this field because I don't like paperwork (laughter).
DEMBOSKY: On that first point, money, insurance companies acknowledge that they may have to raise their rates to attract more therapists in some areas. But Charles Bacchi of the trade group California Association of Health Plans says it's also on therapists to compromise.
CHARLES BACCHI: It's unrealistic to expect for health plans to just pay providers whatever they ask to be paid.
DEMBOSKY: He says providers can either serve people who can pay market rates or be part of the health care system.
BACCHI: Our job is to find providers that are willing to be part of the solution, are willing to provide coverage to those of low and moderate income and are willing to be part of our health plans.
DEMBOSKY: That's exactly how San Francisco psychologist Jonathan Horowitz feels. He wants to take insurance, but he's hit roadblock after roadblock. He sent out 10 applications to insurance companies and got nowhere.
JONATHAN HOROWITZ: I might knock on Cigna's door and say - hey, are you guys accepting any new therapists in 94105? And they might say no, we're not doing that. We're totally full.
DEMBOSKY: Six companies told Horowitz their networks were full. So even though a patient might call 10 therapists on the lists and be told there are no appointments, insurance companies are telling new and willing therapists that there's no demand for them.
HOROWITZ: I definitely think it's to control costs.
DEMBOSKY: After a year, one company finally said yes - sort of. Horowitz never got a formal notice saying his clinic was admitted to the network.
HOROWITZ: It was just, like - oh, wait. It looks like we're suddenly getting a couple referrals from them. I wonder if they're in their directory.
DEMBOSKY: They were - sort of. The clinic was listed, but the therapists who work in the clinic weren't.
HOROWITZ: Oh, here's a number.
DEMBOSKY: So Horowitz tried to call the insurance company to clear things up. He tried many, many times.
VOICE RECORDING: Hello. This call may be recorded for quality purposes.
DEMBOSKY: I sat with him during his latest attempt.
VOICE RECORDING: First, I'll need your provider identification number. If you need a moment, say hold on.
HOROWITZ: Hold on.
VOICE RECORDING: You can also...
DEMBOSKY: Sound familiar?
VOICE RECORDING: OK. When you're ready...
DEMBOSKY: Turns out, therapists get the automated runaround as much as patients do.
VOICE RECORDING: OK. Please say or enter your PIN.
HOROWITZ: My PIN - is this my PIN?
DEMBOSKY: They go back and forth on that one a few times.
VOICE RECORDING: I'm sorry. I couldn't find an account using the information you gave me. Do you already belong to the network?
HOROWITZ: I think so.
VOICE RECORDING: Sorry. Yes or no?
HOROWITZ: I don't know. Yes?
VOICE RECORDING: All right. And have you already requested a credentialing application?
VOICE RECORDING: Sorry. Could you repeat that?
DEMBOSKY: You get the idea.
HOROWITZ: So I honestly got a really bad feeling about it.
DEMBOSKY: Horowitz figured if this is what it's like just finding out if he's in the network, how is it going to be when he has a problem with a claim and can't get paid?
HOROWITZ: I could just see that getting out of hand really quickly. So at that point, we just said - do we really even want to do this?
DEMBOSKY: Not just that, the reimbursement rate was even lower than he expected. And the billing was so complicated, he was going to have to hire someone to do it. He says he couldn't afford that.
HOROWITZ: And we just made the decision that we're just going to cancel the contract and just continue to go with cash.
DEMBOSKY: Easier said than done. Horowitz hasn't been able to get through to anyone to cancel the contract. For NPR News, I'm April Dembosky in San Francisco.
INSKEEP: Well, that story got through to us thanks to a reporting partnership with NPR, KQED and Kaiser Health News.
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