Paying Out Of Pocket For Your LA Therapist? You're Not Alone

A new study on mental health care suggests a dearth of providers willing to accept insurance. (Rebecca Plevin/ KPCC)

Francesca Cuttia works at an L.A. hospital as a physician's assistant and gets her insurance through her employer. Despite working in the health care field, she says she has to pay about $150 out of pocket weekly to see her therapist.

Costly, yes. But necessary, she says.

"I'm burdened with tons of student loan debt," Cuttia says, "but I also feel my health is my wealth, essentially."

Cuttia isn't the only one shelling out extra cash for mental health services. In 2017, Californians with workplace PPO health plans were four to eight times more likely to pay out of pocket for mental health services, like therapy and substance abuse treatment, than they were to pay out of pocket for physical health care needs, like a sprained ankle or a surgical procedure. That's according to a new study by health care consulting firm Milliman.

And the percentage of patients going out of their insurance network for inpatient and outpatient mental health treatment has jumped since 2013, according to the study.

This accessibility problem is occurring alongside high rates of depression and suicide among Americans, especially among youth.

Suicide rates among people 10 to 24 years old rose 56% from 2007 to 2017, according to the Centers for Disease Control and Prevention.

Dr. Henry Harbin is a psychiatrist who advises the Bowman Family Foundation, which paid for the study on mental health and insurance. He says fewer and fewer mental health providers are taking insurance.

That's the problem Cuttia ran into when looking online for a therapist within her insurance plan.

"I went to actually go visit some of these providers and I'm often told once I get there, 'You know, I actually am not in-network or don't participate with insurance,' Cuttia says.

INSURERS DON'T PAY MENTAL AND PHYSICAL HEALTH COSTS EQUALLY

The study found that insurers reimbursed primary care physicians at higher rates than comparable behavioral health professionals — 15% higher in California. Harbin believes that's why many mental health providers aren't joining health insurance networks.

According to federal law, mental and physical health care should be equally accessible.

In 2008, Congress passed the Mental Health Parity and Addiction Equity Act, which requires large group help plans to provide the same level of mental health care as they do physical health care.

The law also says insurers have to reimburse mental health providers at the same rate they reimburse physical health providers. The U.S. Department of Labor is charged with ensuring compliance, but Harbin says more needs to be done.

"The federal government has to step up their enforcement," he says, adding that the government should require private health plans to provide transparent data.

In the meantime, some experts worry that patients aren't getting potentially life-saving mental health help. Cuttia says she's lucky to have the means to pay out of pocket for her therapist.

"You know, my student loans get paid over time but my mental health is forever."