ROBERT SIEGEL, HOST:
Millions of Americans suffer from depression, anxiety or other mental illnesses every year. But many never get help, even if they have insurance. Recent health laws were supposed to fix that, but they're not working. From member station KQED in San Francisco, reporter April Dembosky brings us this story.
APRIL DEMBOSKY, BYLINE: Natalie Dunnege's 12-year-old son Strazh hangs from the monkey bar staring at the ground. The other kids in the park aren't interested in him, and he's not interested in them.
STRAZH DUNNEGE: I just like to play by myself.
DEMBOSKY: Strazh has autism. His mom says today is a good day. But on most others, Strazh has meltdowns. Something frustrates him, and he can't control his emotions.
STRAZH: I sometimes end up screaming, and I end up yelling and screaming.
NATALIE DUNNEGE: And like hitting and banging things, throwing things.
DEMBOSKY: Strazh's mom, Natalie, says she bears the brunt of these meltdowns.
DUNNEGE: He told me that I disgusted him, tells me he hates me.
DEMBOSKY: Dunnege puts all her spare money into therapy for Strazh. She says it helps a lot, but Dunnege herself is struggling, feeling depressed and overwhelmed. She said she needs her own therapist.
DUNNEGE: One of the things that I've really had to wrap my head around is that I can't change him. I can only change how I handle the situation - and not that I would want to change who he is. He's a really good kid, but it's a lot to handle especially as a single parent.
DEMBOSKY: I first talked to Dunnege last year when she started looking for a therapist. She realized her co-pay for a mental health visit was upwards of $75, even though her co-pay for other medical appointments was less.
DUNNEGE: My income - I'm like - just made lower-middle income just by the skin of my teeth. So I just kind of have to hold off until I'm actually middle-class.
DEMBOSKY: Co-pays for medical and mental health treatments are supposed to be the same. Almost all insurance companies in California are struggling with this. Twenty-four out of 25, including Dunnege's insurer, Anthem Blue Cross, were recently required to fix unequal cost-sharing policies by the state's Department of Managed Health Care. That's according to agency documents and staff.
In a statement, Anthem said it is working with the department to comply with the law and meet the mental health needs of its customers. Since last year, Dunnege got a promotion at work and moved into a new apartment. Her health benefits got an upgrade, too. She has Blue Shield now and her co-pay for mental health appointments is only $20.
DUNNEGE: Which I was really excited about.
DEMBOSKY: But this time, when she looked for therapists who took her insurance, she struck out again.
DUNNEGE: I contacted like six or seven.
DEMBOSKY: Three called her back.
DUNNEGE: One of them - they were completely booked, and then the other two just didn't accept the insurance anymore.
DEMBOSKY: Zero hits out of seven - had to be a bad draw, right? No. I did my own survey. I called all the psychologists that came up on the Blue Shield website for Natalie's plan in San Francisco. There were 100.
UNIDENTIFIED WOMAN #1: Please leave a message.
UNIDENTIFIED MAN #1: Please leave a message
UNIDENTIFIED WOMAN #2: Please leave a message and I will...
DEMBOSKY: Almost a quarter of them never called me back.
UNIDENTIFIED WOMAN #3: If you don't get a call back from me, that means my practice is full.
DEMBOSKY: Nearly half said they weren't taking insurance anymore or weren't accepting new patients.
UNIDENTIFIED MAN #2: Sorry about that.
UNIDENTIFIED WOMAN #4: I'm sorry I'm not...
UNIDENTIFIED MAN #3: Unfortunately...
UNIDENTIFIED WOMAN #5: I unfortunately don't have any openings at the moment.
DEMBOSKY: So that left just a quarter of the therapists on the list who actually had appointments. And of those, exactly eight had slots after work hours.
UNIDENTIFIED WOMAN #6: At the moment, I only have daytime appointments available.
DEMBOSKY: Eight out of 100.
UNIDENTIFIED WOMAN #6: Wishing you the best.
UNIDENTIFIED MAN #4: Sorry. Good luck with that.
UNIDENTIFIED WOMAN #7: Good luck with that.
UNIDENTIFIED MAN #5: OK. Good luck. Bye-bye.
DEMBOSKY: For Natalie Dunnege after seven rejections, she just gave up looking.
DUNNEGE: It's hard when you're feeling sad, and you're like in this very - like you feel like you can barely keep things together. It just seemed like way too much at the time.
DEMBOSKY: Mental health advocates say this is actually a strategy for insurance companies.
KEITH HUMPHREYS: It's a way to control cost.
DEMBOSKY: That's Stanford psychiatry professor Keith Humphreys. He's the guy who advised Congress when it was developing a law that was meant to fix this. But while insurers are required to keep a solid number of clinicians in their directories, he says they still find ways to sidestep the rules.
HUMPHREYS: The law doesn't say, well, you can't put people on there who are dead or you can't put people on there who are not taking new patients. And so what that translates into then is people have to wait longer for care, which then cuts expenditures for the insurer and reduces access.
DEMBOSKY: Blue Shield declined to do an interview, but said in a statement that it's up to the therapist to update their availability online. Charles Bacchi of the trade group the California Association of Health Plans acknowledges that's a challenge in mental health care where the workforce is mainly self-employed, solo practitioners.
CHARLES BACCHI: When you have networks as large as ours, and you have as many enrollees as we have here in California, you're not going to be able to just have everything accurate every single second of every single day.
DEMBOSKY: Meanwhile, people like Natalie Dunnege are toughing it out on their own. For NPR News, I'm April Dembosky in San Francisco.
SIEGEL: That story is part of a reporting partnership with KQED and Kaiser Health News.
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