As two members of the General Assembly from the field of social work, one of the most consistent and heartbreaking issues we hear about from our residents is how difficult, and sometimes impossible, it is to find a mental health professional who accepts their insurance.
Most of us have experienced, or know someone who has experienced, the headache of trying to find an “in-network” provider so we don’t have to pay thousands of additional dollars out-of-pocket every year for therapy or psychiatric care. Distraught parents, neighbors and friends who are trying to find an in-network provider covered by insurance reach out to us regularly.
Imagine you have a child, struggling with chronic anxiety or depression, self-harming or withdrawing to cope — and you cannot connect them with a professional for months, or you must pay thousands of dollars upfront for them to see an out-of-network provider. This problem is pervasive in every legislative district across Illinois.
With the average price of one therapy visit around $150, costs add up quickly, especially when multiple family members may need weekly or monthly visits during crises, while grieving, or for regular life stressors.
It’s not just consumers who feel this strain — it also puts an enormous stress on mental health provider practices, many of which are independent or small businesses. Too often, these professionals are forced to choose between accepting dismal reimbursement rates that fail to cover their costs or leaving networks and relying on “self-pay,” rendering mental health care unaffordable for most.
Insurance coverage for mental health remains wholly inadequate, despite numerous federal and state laws passed in the last two decades. For real access and affordability, insurance companies must do their part.
That’s why we, and so many of our colleagues, are championing Senate Bill 55 and House Bill 1085 to make Illinois insurance coverage for mental health care — from therapy to psychiatry — accessible for all.
Low reimbursement, too much red tape
Insurance companies are simply not doing enough to attract mental health professionals like counselors, social workers and psychologists to their networks. Thousands of Illinoisans pay monthly insurance premiums but are still forced to go out of network for care, and pay out of pocket, because so many providers avoid insurance since reimbursement rates are so low and the burden of red tape is so high.
Our legislation would require insurance plans to change this dynamic by reimbursing mental health professionals adequately and incentivizing them to join insurance networks. Illinois data compiled by the Research Triangle Institute shows that when measured against widely accepted pay benchmarks, behavioral health is reimbursed between 23% to 52% less than other medical care. As a comparison, primary care physicians are in short supply, yet very few people are forced to go out of network and pay out of pocket because insurance plans pay sufficiently — so primary care clinicians join networks.
Countless additional studies have found that insufficient mental health provider networks are not simply due to the mental health workforce shortage. Because Illinois insurance companies have failed to meaningfully change their reimbursement practices for mental health, insurance networks are shrinking at the exact time we need them to grow.
People desperately need support and can’t afford to shell out hundreds in out-of-pocket costs. These insurance practices persist even though the industry is well aware of the challenges consumers — our constituents — face in finding “in-network” providers and the alarming increase in rates of depression and anxiety (particularly in teens and young adults), suicide and drug overdoses.
It is time for Illinois to step in where insurance companies are failing families. We must pass these bills.
State Sen. Karina Villa serves the 25th Senate District. She has a master’s in social work. State Rep. Lindsey LaPointe serves the 19th House District. She has a master’s in social work and is a licensed social worker.
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