As the demand for mental health care services grows, navigating payer processes can be extraordinarily complex and challenging for psychiatric practices. Reimbursement is essential to covering practice overhead, yet it’s become increasingly challenging to rely on from insurers. Studies show that approximately a quarter of clinicians rely on patient self-pay, a trend that has been ticking upwards for the last decade. This is a significant barrier to care for many Americans; in a recent report, 42% of adults with a mental illness said they were unable to receive necessary care because they couldn’t afford it. While psychiatry practices move to private pay to stay in business, patients who rely on insurance coverage to access mental health care suffer as a result.
Streamlining insurance claims processes can be a game changer for psychiatric practices, enabling new, more consistent streams of income as well as opening up options for patients who couldn’t afford care otherwise. Here are five reasons psychiatrists need easier ways for patients to use health insurance for mental health care access.
- More treatment options are in the pipeline. One newer treatment method, transcranial magnetic stimulation (TMS) is widely covered by insurance, highlighting the importance for mental health practitioners to embrace insurance practices to extend its accessibility to a broader patient base. Although IV ketamine remains uncovered, the introduction of an FDA-approved version, esketamine, since 2019 has seen widespread insurance coverage. Anticipating FDA approvals for MDMA and Comp360 (psilocybin) in the coming years, we have secured new CPT codes for these treatments, ensuring their eventual coverage by insurance. Clinicians who lag in adopting these advancements risk being left behind, limiting patient access to these evolving therapies.
- Fewer denials and faster insurance reimbursements. Automating the insurance claims process translates to quicker reimbursements for mental health practitioners. By reducing the incidence of claims denials, psychiatrists can focus more on patient care and less on administrative hassles. This efficiency not only benefits the clinicians, but also translates into a better experience for the patients, who can access timely and uninterrupted mental health support.
- Save time through improved visibility and operational predictability. Clinicians spend a massive amount of time on administrative tasks, and psychiatrists spend the most (20%), taking away from time spent on direct patient care. Automating claims processes can save significant time for psychiatrists as well as patients. With resulting improved operational predictability, psychiatrists can gain better visibility into their financial operations, enabling them to plan more effectively, invest in staff and resources, and ultimately enhance the quality of care they provide to their patients.
- Serve more diverse patients. One of the most significant advantages of an efficient insurance claims process is the ability to extend mental health care to marginalized populations. By simplifying access to mental health services, psychiatrists can reach out to people who might otherwise be unable to afford these services. This can also help address disparities in mental health care, ensuring that everyone, regardless of their background, has access to the support they need.
- Supporting evidence-based research. It’s important that psychiatry build pathways to universally quantify progress so that it’s something an insurance company will readily reimburse. This data is also essential to validate clinical effectiveness of the novel treatments that are perhaps the only option for the nearly three million Americans who have treatment-resistant depression. With increased efficiency in claims processing, mental health practitioners can participate in and contribute to evidence-based research. This research, in turn, serves as a foundation for expanding insurance coverage, advocating for policy changes, and improving overall mental health care accessibility.
By embracing efficient claims handling, mental health practices can usher in a new era of accessibility, affordability, and innovation in mental health care, which is needed. Mental health professionals, insurers, and others can create a system where every individual receives the care they deserve, irrespective of their circumstances. No psychiatry practice should face the decision of whether to serve patients in need or maintain a solvent business. The goal is for psychiatric treatments to be recognized and appropriately reimbursed by payers in a straightforward and streamlined way, which also helps millions of patients across the U.S. gain more affordable access to necessary care.
Carlene MacMillan
Carlene MacMillan, MD, is Chief Medical Officer at Osmind, the public benefit corporation helping clinicians and researchers advance new life-saving mental health treatments, where she focuses on product, growth, and medical affairs. She is also the co-chair of the Clinical TMS Society Insurance Committee and co-chair of the American Academy of Child and Adolescent Psychiatry Consumer Issues Committee.
