The number of people experiencing symptoms of depression and anxiety almost quadrupled During the covid pandemic, Which makes it more difficult to get mental health care in time, even if you have good insurance.
A sort of California law Governor Gavin Newsom signed on October 8th to help. It requires mental health and substance abuse patients to return to their appointment no more than 10 days after the last treatment, unless their provider can reduce the frequency of visits.
Current insurance regulations already require patients to be given initial mental health visits within 10 days of their request. But until now, there is no specific content about follow-up care in the book.
The law will not go into effect until July, and legislators say it will give health plans time to comply-mainly by hiring or contracting more therapists. Proponents say that through effective enforcement, the new law will help many people get the care they need.
SB 221 bill “will ensure that people can actually use their insurance to get mental health treatment,” said Senator Scott Wiener (D-San Francisco), the author of the bill. “For a long time, health plans have often made people wait a long time to get a mental health appointment, which hurts their care.”
If you do not get the care you need, you can seek remedy in many ways. When the law comes into effect in eight months, it will strengthen your power. It will be described in detail later.
There are two conflicting explanations for why it is difficult to obtain consistent mental health care. Insurance companies say there is a shortage of therapists. The therapist said that the insurance company was too cheap to pay them enough. Many therapists refuse to join the insurance network and set their own fees, which many people cannot afford.
The National Union of Health Care Workers, which supports the legislation, particularly criticized Kaiser Permanente, the state’s largest commercial health insurance company, for its well-known mental health deficiencies.
Kaiser Permanente, and More than 9 million members In California, yes Fined 4 million U.S. dollars In 2013, he was recognized by the state regulatory agency for failing to provide mental health care in a timely manner. Since then, it has been cited twice for failing to solve the problem.
Former and current KP therapists said that the managed care giant has worked hard to ensure that members seeking mental health treatment get an initial appointment as soon as possible to resolve complaints. But this will only make it more difficult for these patients to receive follow-up treatment, the therapist said.
“Any available appointments will be provided to those who need to start the service,” said Susan Whitney, a marriage and family therapist, who worked at Kaiser Permanente in Bakersfield for 18 years and then in September Left the organization. “Our schedule will be filled for six to eight weeks-so it is difficult to make follow-up appointments, to say the least.”
The American Psychological Association recommends that patients with depression receive treatment once a week, and patients with post-traumatic stress disorder receive treatment twice a week.in a letter The association told the California Department of Managed Health Care last year that the long-awaited follow-up care reported by KP patients and therapists was “far below the appropriate level of care for most patients.”
Due to the lack of available therapists, Kaiser Permanente often recommends its members to external network providers for mental health treatment. But members, therapists and public officials said that these networks are often not possible.
Maya Polon is a member of KP in Sacramento. After taking care of her terminally ill grandmother, she began to feel emotional breakdown in March. She tried to get help through Kaiser, but had to make countless calls and kept receiving conflicting information about how to get care.
Finally, more than a month later, a Kaiser Permanente therapist told Polon, 27, that her depression, anxiety, and panic attacks made her eligible for one year of treatment. But if she wants to do it through Caesar, then her first date will take six months.
KP referred her to Beacon Health Options, an external mental health contractor, who took two weeks to send her a list of therapists. She called all the 20 providers on the list during the workday break and left a message.
“As a person suffering from anxiety and depression, I have to take the initiative to sit down and call you over and over again to tell you,’Oh, I don’t actually accept new patients,’ this is an overwhelming failure process. “Bolong said. “I got rid of this thought,’If this is something I have to go through, do I even want to get treatment?'”
She eventually met a therapist who provided her with space, but she did not sign with Beacon. Polon had to argue with Kaiser Permanente over paperwork for months.
In June, San Diego City Attorney Mara Elliott (Mara Elliott) Sue Caesar She called it the “ghost network,” which “wrongly described the breadth of the insurance company provider network, promising consumers that health care would not actually be available under the plan.” Elliott sued Molina Healthcare with Health Net Based on similar reasons.
Dr. Yener Balan, vice president of behavioral health and professional services at Kaiser Permanente in Northern California, said the organization can do better, but claims that it has 84% of the time to meet the follow-up appointment recommendations of its mental health clinicians-a number that is influenced by union officials Intense argument with the therapist.
Balan said the July implementation date of SB 221 is very helpful, “given that all healthcare organizations face a shortage of mental health clinicians.”
Critics of the health insurance industry question whether the shortage of therapists is the main problem. Wiener said the health plan did not pay enough mental health practitioners to join their network.
A 2019 report The California Future Health Manpower Commission predicts that within ten years the number of psychiatrists will be 41% less than required, and the number of psychologists, marriage and family therapists, and other mental health workers will be reduced by 11%.
But one report In the same year, the State Legislative Analysis Office stated that the number of graduates from the mental health program had increased significantly-despite reports that there was a shortage of psychiatrists.
The agency spokesperson Rachel Arrezola (Rachel Arrezola) said that the Department of Management Health Care is responsible for overseeing health plans that cover the vast majority of Californians. It will monitor compliance with the new law and investigate consumer complaints.
what can you do
If you think your health plan is insufficient in terms of mental health treatment, you don’t have to wait for the new law to come out. You can challenge your insurance company According to current regulations. However, once the law goes into effect, it will provide additional ballast for any challenges and allow regulators to develop health plans for violations.
To dispute the lack of coverage, you must first file a complaint directly with your health plan. If you are in a private plan, you must file an appeal within six months of the denial of care. The insurance company must make a decision on your appeal within 30 days.
If you do not get a satisfactory decision, please submit your case to the agency that supervises your insurance company for independent review. If there is an emergency health risk, you do not need to wait 30 days. Contact your supervisory authority immediately.
To find out which agency it is, please call the customer service hotline of your health plan.If it’s a managed healthcare department, you can call 888-466-2219 or log in HealthHelp.ca.govIf your regulatory agency is the California Department of Insurance, please call 800-927-4357.
If you receive Medi-Cal for managed care and your plan is supervised by the Department of Managed Health Care, you can ask that department to conduct an independent review.You can also, like any Medi-Cal beneficiary, seek a “fair hearing” through the state government and go to online Or call 855-795-0634.
Of course, all this requires time and energy. However, if the delay prevents you from receiving treatment, it may be worthwhile.
Photo: SIphotography, Getty Images
Caesars Health News (KHN) is a national health policy news service.This is a program independent of editing Henry J. Caesar Family Foundation Not affiliated with Kaiser Permanente.
