How brokers can help
By Carmen Ponce
Accessing mental healthcare is a major challenge in the United States, with many people facing significant barriers to getting the help they need. One of the biggest issue is the lack of available mental health providers and the adequacy of healthcare companies’ mental health networks. According to a CNN/KFF poll, 90% of American adults believe that the United States is experiencing a mental health crisis, highlighting the urgency of addressing this issue. (Link: )
Unfortunately, many health care companies do not have adequate networks of mental health care providers, making it difficult for individuals to find a therapist or psychiatrist in their area. This is due to the prevalence of “ghost networks,” where directories appear accurate but include providers that are not actually in-network or are not accepting new patients. It can be challenging for individuals to locate a provider that accepts insurance at all, much less participates in their insurer’s network. In addition, some providers only
accept certain types of insurance plans — such as the PPO and not the HMO — which can cause confusion and frustration for patients. (Link:)
Broker’s valuable role: offer resources
As brokers, we have an important role to play in helping individuals access mental health care. We need to help clients understand their coverage and networks and coordinate with the health plan carrier to access care. It is essential that we know the laws and regulations regarding mental health care and be strong advocates for our clients.
All Affordable Care Act (ACA) medical plans have mental health benefits, but most members of health plans are waiting an average of 1 to 2 months for an appointment.
California law requires health plans to provide timely access to care. This means that there are limits on how long individuals have to wait to get health care appointments and telephone advice.
If individuals have problems getting timely access to care, they should call their health plan and ask for assistance. If the plan does not resolve the problem, contact the Dept. of Managed Health Care (DMHC) Help Center. (Link:)
Also, there is a federal hotline — 988 — billed as an alternative to 911 for people experiencing mental health emergencies. Advocates say the 988 shortcut will make it simpler for people in crisis to tap into the state’s network of 13 National Suicide Prevention Lifeline call centers.
Stigma hinders access to mental health
Another significant issue in accessing mental healthcare is the stigma associated with mental illness. Many people are reluctant to seek help because of the negative attitudes and stereotypes that surround mental health issues. As brokers, we can become trusted advocates who help de-stigmatize the individual’s mental health needs. We can also help clients find care by coordinating with the health plan carrier.
The lack of access to mental health care can have serious consequences for individuals and society as a whole. Mental health issues can lead to physical health problems, relationship difficulties, and a reduced quality of life. In addition, untreated mental illness can result in increased healthcare costs and lost work productivity. As brokers, it is our responsibility to help break down barriers to mental health care and ensure that our clients receive the care and support they need to thrive.
Finally, it is important that brokers gain a better understanding of what mental health coverage and resources are available. We need to be able to provide relevant information about mental healthcare benefits, networks and resources, and to help our clients navigate the often-complex world of mental healthcare. Through our compassion, assistance and advocacy, we can help destigmatize mental illness and ensure that individuals have access to the care they need to live healthy, fulfilling lives.
Carmen Ponce is VP of Client Services and Renewals at Calhoun & Associates Insurance Services. She is a 15-year veteran of health insurance, specializing in Small Group benefits. She grew up in Orange County, and is a wife and mother of three.
Contact: carmen@integrity-advisors.com