Clinicians saying goodbye to insurance networks

One primary reason the shortage of clinicians persists is because of insufficient insurance reimbursement.

Many psychologists, as well as psychiatrists and social workers, are choosing to no longer participate in insurance networks, which, in turns, leaves many people without access to mental health care because they cannot pay for it out of pocket.

New Hampshire has recently been calling attention to this widespread problem.

Members of Clinicians United New Hampshire contributed to an Op-Ed in the New Hampshire Bulletin, which said, in part, “The only recourse for providers should not be to leave that system as it only stands to hurt the very patients we are trying to serve.”

“The fact that insurance companies control so much of the market means they have an ethical duty to partner in their paying member’s care and with their contracted providers to improve the health of our citizens—a responsibility they are choosing not to live up to,” the organization wrote.

David Meichsner, LICSW, MBA, is a counselor at Women’s Counseling of Nashua and a member of Clinicians United of New Hampshire, who co-authored the Op-Ed.

He spoke about a frustrating situation with one insurer that dropped one of the clinicians at his workplace because they erroneously said the person was not contracted.

Following several phone calls, the insurer admitted it was a system error. However, a year and a half later, the issue still has not been resolved. The state’s insurance department dropped the case because the individual insurance company said they were fixing the issue.

“I’ve estimated that if I didn’t have to deal with insurance payments, I could get 15 more patients in my practice,” Meichsner said. “You have to be a clinician, a businessman, an attorney, and an advocate.”

He noted a clinician does the work, invoices or submits the claim and then must prove “there is no way they cannot pay you.”

He said the situation is getting worse.

“We have gotten some ridiculous responses, like being told that generalized anxiety disorder is not a real mental health problem. They are getting sneakier and there’s no one to hold them accountable,” he said.

D.J. Bettencourt, the New Hampshire Insurance Department commissioner, said in published reports the “breadth and consistency,” of issues they are hearing from behavioral health providers is “very concerning.”

Bettencourt said these issues with reimbursement are not just a one-off, but matters that require systemic solutions.

Lynn Stanley, LICSW, executive director of the National Association of Social Workers (NASW), said leaving insurance networks is an inequitable solution.

She noted there are clinicians who have clients needing health services who are willing and can afford to pay out of pocket.

“If you have enough people in your practice that do have enough money, then it becomes an equity issue. You are not serving the people who can’t,” she said.

Shawn Hassell, MS, LMFT, AAMFT is supervisor at the Between Us Associates, LLC, located in both Manchester and Salem. He is also a member of Clinicians United New Hampshire.

He is concerned that only wealthier people will get the mental health care they need.

“This isn’t just theoretical,” he said. “It’s already happening. It’s a justice issue that disadvantages lower income people.”

Stanley said when large medical facilities like Concord Hospital have upwards of 60 people in the billing department tracking down insurance payments, the individual therapist does not have a chance.

“It’s more work than it is worth to fight it,” Stanley said.

Hassell echoed that view. His practice decided not to pursue retroactive denials below $400. Yet he added they cannot really afford to operate that way.

Julie Wolter, Psy.D., is the director of professional affairs at the New Hampshire Psychological Association (NHPA) and chair of the Behavioral Healthcare Advocacy Committee (BHAC).

Wolter said she and her colleagues with NHPA, BHAC conducted a survey in 2023 that showed some disturbing facts. Clinicians say that it has become increasingly more difficult to find a therapist with availability, reimbursement continues to be a major problem, and there is an aging workforce that can’t seem to attract new clinicians.

As to insurance reimbursement, she put a final point on what this means if things do not change.

Agreeing that fewer people will be able to afford mental health care, Wolter said New Hampshire does not have the infrastructure to cover mental health costs for uninsured, underinsured, or those who cannot afford the cost shares.

She said via email, “Our entire mental health care system is at risk of being only available to those of higher income levels who can afford to pay out of pocket. Practices and our community mental health centers cannot bear the financial responsibility of an unaffordable system of care. It will also continue to impact interest in the field if income is not competitive to other fields.”