America is in the midst of a mental health crisis, but finding a therapist who takes insurance can feel impossible. Insurers say it’s because there aren’t enough therapists. That’s not entirely true.
To understand the forces that drive even the most well-intentioned therapists from insurance networks, ProPublica plunged into a problem most often explored in statistics and one-off perspectives. Reporters spoke to hundreds of providers in nearly all 50 states, from rural communities to big cities.
The interviews underscore how the nation’s insurers — quietly, and with minimal pushback from state and federal lawmakers — have assumed an outsize role in mental health care.
It is often the insurers, not the therapists, that determine who can get treatment, what kind they can get and for how long. More than a dozen therapists said insurers urged them to reduce care when their patients were on the brink of harm, including suicide.
All the while, providers struggled to stay in business as insurers withheld reimbursements that sometimes came months late. Some spent hours a week chasing down the meager payments, listening to hold music and sending faxes into the abyss.
Therapists have tried to stick it out. They have forgone denied payments. They have taken second jobs. They have sought therapy for their own support. But the hundreds who spoke with ProPublica said they each faced a moment in which they decided they had to leave the network.
