Local Mental Health Requests Double

By John Voket

Connecticut’s Office of the Healthcare Advocate reported last week that 30 percent of 337 mental health providers listed in six major state HMO networks were not taking new patients. This trend likely accounts for an explosion of requests for mental health services through Newtown’s merging Family Counseling Center and Youth Services agencies.

Beth Barton, the executive director and spokesperson for the Newtown organization, confirmed Tuesday that appeals for services are far outpacing the availability of slots with mental health professionals and support staff.

“The amount of new patients we are serving has almost doubled from last year, however we continue to have about a four-week waiting list,” Ms Barton said in an e-mail response to questions from The Bee about caseloads.

She pointed out that almost all similar nonprofit agencies in the region have a waiting list that is about four to six weeks.

“The demand for services far exceeds the number of providers,” Ms Barton said.

The Newtown-based Family Counseling Center, which is officially merging with Newtown Youth Services July 1, attempts to respond to crisis cases within a day or two of receiving a call to the agency.

The doubling of requests to the second-tier, quasi-public mental health agency makes sense when examining the findings from the state survey.

Many mental health therapists listed as available by Connecticut HMOs are not accepting new patients and sometimes do not participate in the health plans that list them, according to the report.

The survey, led by a Yale School of Public Health assistant professor, also found that 17 percent of 612 sampled names were inaccurate in the HMOs’ network lists of mental health providers.

They had either retired, moved out of state, lacked a working phone number, left the practice and had no forwarding information, or died.

“Taken together, these findings suggest HMO enrollees may encounter substantial difficulty when trying to find an in-network mental health provider,” said Kevin Lembo, state health care advocate.

“It’s safe to say that if at any given time, 30 percent are not taking new patients, perhaps managed care companies need to create more robust networks to better serve their enrollees,” he said.

Traditional HMOs require members to use only in-network care providers to get coverage. Some other health plans might allow out-of-network care, but at a higher co-pay.

Keith Stover, a lobbyist for the Connecticut Association of Health Plans, called the survey “a political statement, not research.”

Stover said he is “always suspicious of a survey that is designed to prove a philosophical position, which is clearly what this is.”

Asked why they were not accepting new HMO patients, about 56 percent of mental health providers in the survey said they had no more appointment times available, and 11 percent cited insurers’ authorization and review rules as too cumbersome.

Twelve percent said insurers’ reimbursement rates were too low. According to Ms Barton, 60 percent of the Family Counseling Center clients have insurance.

“[But] the administrative cost for using insurances is very high,” she said. “The agency and each individual therapist has to go through a credentialing process for each insurance provider, which can take several weeks. Then it becomes an issue of in or out of network.”

Ms Barton said part of the challenge is a lack of parity among insurers’ reimbursements.

“For every dollar we spend, we are reimbursed 60 cents,” Ms Barton said. “Many private practitioners have opted not to take any insurance and have their clients pay them directly. All of these factors result in a barrier to service and has many people coming to nonprofit agencies more than they have in the past.”

The move on the part of insurance-funded providers to restrict new patients through HMO referrals comes at a time when more people are seeking alternate access to mental health support because they fear for their privacy. In a recent series, The Newtown Bee reported on the many ways in which seeking treatment for mental health concerns can affect future access to employment and insurance coverage.

Privacy concerns have also inspired a nonprofit service-based provider to establish itself in Connecticut. Volunteers in Psychotherapy (www.CTVIP.org) was constructed by licensed psychologists to be a charitable service in which all people can earn psychotherapy services, by volunteering privately and independently elsewhere, for the charity of their choice.

Founder Dr Richard Schulman said participating licensed psychotherapists agree to receive less than half the average local fees, paid from tax-deductible donations that support the organization.

“We ourselves donate all administrative work, office space, and phone to make this system function,” Dr Schulman said. “Since we maintain our clients’ confidences — with no reporting to insurers or documentation in medical records — we can preserve the uniquely frank exploration of difficult personal and familial circumstances which is the heart of psychotherapy.”

Regarding the issue of HMO compensation for services, Dr Schulman believes ever since the use of “managed care” controls over payment for mental health services, contracting professionals and policy holders have learned how insurers can inflate their profits by limiting access to those very services.

“For over ten years there have been descriptions of various forms of invisible rationing such as lists of phantom participating providers — one of several dodges insurers use to give the impression they are providing adequate access to assistance,” he said, “while they are in fact making it difficult for individuals to attain a potentially expensive confidential relationship with a therapist.”

Contracting psychotherapists are often required to file reports with insurers on their intimate discussions with their clients, Dr Schulman added, which is an additional interference that particularly undermines therapy’s privacy.

“Presumably the shareholders and executives in such for-profit companies don’t complain about the additional profits which can be produced in all these ways,” he said.