Several proposals to address gaps in the system are circulating on Capitol Hill. Loophole for mental health care

Even if you get insurance under the new health care law, that’s no guarantee you’ll be able to pay your shrink.

With mental health on the front burner since the Newtown, Conn., school shooting, Democrats have pointed out that the Affordable Care Act expands access to mental health care in several ways. It will get coverage for more people, either through private plans or Medicaid — and the benefits will have to include mental health. A number of other proposals are circulating on Capitol Hill to address gaps in behavioral health.


But all that won’t help much if psychiatrists, psychologists and counselors don’t accept insurance. No one keeps tabs on precisely how many of the 552,000 mental health professionals in the U.S. — according to the Bureau of Labor Statistics — won’t accept private health insurance. But patient advocacy groups and provider organizations say many don’t want to accept low pay rates — and the insurance paperwork.

“It does come up regularly, and I’ll tell you where it’s especially acute — there’s a tremendous dearth of practitioners for children, and of the few who are there, many, many of them don’t take insurance plans,” said Debbie Plotnick, senior director of state policy for the advocacy group Mental Health America.

Andrew Sperling, a lobbyist for the National Alliance on Mental Illness, said, “There are a lot of private practice psychiatrists who refuse to accept the lower rates offered by a plan, particularly for outpatient services, so that can create an access problem.”

A 2008 survey by the American Psychological Association found that 85 percent of licensed psychologists reported receiving some third-party payments. But a majority of those claims were paid by federal, state and local government programs.

That means that many Americans struggling with mental illnesses must pay out of their own pocket for talk therapy — which can run a couple of hundred dollars for a session — and other treatments.

Of 5.7 million adults who didn’t get mental health care when they needed it, nearly half blamed cost or insurance issues, according to a 2005 survey by the Substance Abuse and Mental Health Services Administration.

Some therapists try to come up with their own solutions. Joanna Marino, a psychologist in Arlington, Va., who treats eating and anxiety disorders, won’t handle insurance paperwork, but she will help her clients file claims. And if clients can’t afford her fee of $250 per 45-minute session, they can pay less to meet with a doctoral student under her supervision.

In an attempt to fill coverage gaps, Congress enacted the Mental Health Parity Act in 2008, requiring large insurance plans to treat any mental health benefits they offer the same way as physical health benefits. But the law won’t be fully implemented until the Obama administration spells out more specific rules — which mental health advocates have been pressing for.

The problem isn’t so much with Medicaid, which together with assorted other federal, state and local programs pays nearly 60 percent of all mental health care costs in the country, according to SAMHSA. Advocates say Medicaid offers a pretty good mental health benefit, although it varies state to state.

Instead, it’s the people who don’t qualify for government insurance programs who struggle to pay for treatment — often because they can’t find a provider who accepts their insurance or because their health coverage limits treatment.

And in rural areas, psychiatrists, psychologists and mental health counselors are in short supply. According to the Health Resources and Services Administration, 90.6 million Americans live in designated mental health care shortage areas compared with 56.8 million living in primary care shortage areas.

In urban areas, there are more providers — but still access problems.

“You add to the low reimbursement rates, which some of us find insulting or just untenable, the hassle of getting services approved, getting claims paid, dealing with audits, having to fight over whether particular services are covered,” said Alan Nessman, special counsel at the American Psychological Association.