Finding a Therapist: A Challenge for Many

Carrie Carlock never expected the struggle she faced in locating a therapist for her teenager. Even as the CEO of a hospital and a board member of a significant local mental health organization, she found herself unable to secure a therapist nearby who would accept her health insurance.

“I found that completely unacceptable,” Carlock remarked. This experience prompted a career shift; she opened a new therapy clinic in 2021, now boasting six locations.

Currently, she and others are optimistic that a newly passed bill could simplify the process for residents across Illinois seeking therapists who accept private insurance.

In recent years, numerous therapists have opted out of accepting insurance due to low payment rates and the burdensome administrative tasks that often accompany insurance treatment. This trend has led many patients to either forego behavioral healthcare or pay entirely out-of-pocket. The new legislation intends to tackle these issues by establishing a mandated formula regarding how much insurance companies must compensate therapists.

“This is an affordability bill,” explained bill sponsor Rep. Lindsey LaPointe (D-Chicago). “Having to pay a monthly premium along with $250 out-of-pocket for treatment just isn’t affordable.”

The bill also seeks to cut down on red tape. It would prevent insurance companies from demanding extensive documentation for longer sessions compared to shorter ones, mandate coverage for multiple behavioral health services for individual patients in a single day, and ensure that services provided by therapists-in-training under supervision are covered. Additionally, it aims to decrease the time required for therapists to join an insurance network.

Despite passing, the bill faced opposition from representatives of the insurance industry. They argued that setting reimbursement rates by law could lead to increased costs for all policyholders.

Initially, Governor J.B. Pritzker’s office had reservations about the bill earlier this year; however, concerns subsided after modifications were introduced. A spokesperson from his office indicated that a review of the revised bill would take place before any governor’s action.

If signed into law, the changes would impact around 2.5 million Illinois residents enrolled in state-regulated health insurance starting in January 2027. Typically, large corporations have self-funded plans, which are overseen by federal regulations and are not subject to state rules. The bill won’t affect individuals with HMOs.

This legislation was passed this fall, following extensive advocacy from LaPointe for improved access to behavioral healthcare. Thresholds, an organization that supports individuals with severe mental health and substance use challenges in Illinois, had a role in drafting the bill, according to Heather O’Donnell, who is now the director of behavioral health strategies at the DuPage County Health Department.

“I think this bill resonated with people,” O’Donnell mentioned. “Elected officials frequently hear from constituents about the difficulty in finding a therapist, psychologist, or social worker covered by their insurance, and many have faced similar challenges themselves.”

A preceding bill had mandated Illinois insurance companies to compensate in-network therapists 141% of what Medicare pays for treatment and substance use services. LaPointe stated that the new bill continues to project that “roughly” 141% of Medicare reimbursements will be applied.

Prior to its passage, an amendment excluded state employee health insurance to avoid potential increases in their health plan costs. “This was necessary because including state employees could raise their insurance premiums,” LaPointe explained, emphasizing that behavioral health spending represents a small fraction of overall healthcare costs.

Improving access to behavioral health services might lead to savings on physical health expenses in the long term, she added. Passing the bill inevitably required some compromises.

However, Laura Minzer, president of the Illinois Life and Health Insurance Council, which was opposed to the bill, suggested that the exclusion of state employees highlights the bill’s concerns. It could potentially elevate costs for individuals in state-regulated private plans, she argued.

Minzer noted that while the council supported parts of the proposal, there was strong opposition to legally mandating reimbursement rates.

The insurance trade group AHIP also voiced opposition for similar reasons, stating that they will keep working with policymakers “to enhance affordability and access to mental health and substance abuse care.”

Nonetheless, supporters argue that this bill could significantly improve access to therapists in Illinois. Existing federal and state parity laws already require equitable coverage for behavioral and physical health care, but advocates believe more needs to be done, as noted by Mark Ishag, president and CEO of Threshold.

A report from 2019 by Milliman revealed that primary care physicians received about 24% more payment than behavioral health providers for equivalent services during home visits under PPO plans.

Proponents argue this newly passed legislation could help rectify such disparities. “It’s a major game-changer, not just for therapists, but also for individuals seeking services and wanting to utilize the benefits they pay for,” said Carlock from Mosaic Counseling and Wellness. Hers is an insurance-accepting clinic, but Carlock clarified that this decision wasn’t purely financial; it stemmed from a desire to assist as many patients as possible.

Monica Sharma, a licensed clinical psychologist, previously operated a group clinic that accepted private insurance for over a decade. However, she decided to close it last year due to rising costs and stagnant reimbursements. “We hit a wall with payments and refunds,” she recalled, feeling overwhelmed by the administrative challenges that came with accepting insurance.

Sharma opted to start her own practice, no longer accepting private insurance. “During my time in group practice, I felt detached from why I entered this field,” she shared. “Now, I felt I was bound by rules that never aligned with my vision in the first place. The system seemed to favor insurance companies rather than the patients and clients.”

If the recently passed bill is enacted, she mentioned she might reconsider accepting insurance to reach more patients.