In communities across Northern Colorado, people are struggling with their mental health while also struggling to get the care they need.
The problem is widespread. Around a quarter of residents reported having poor mental health in the most recent Colorado Health Access Survey. Out of the 1 in 6 Coloradans who were unable to get needed care, nearly half said they had a hard time getting an appointment, while nearly 60% were concerned about cost.
Fort Collins resident Kristin Vera has lived these statistics while trying to get her teenage daughter help over the past several years.
“Her mood was so extraordinarily low. And of course, I was worried about self-harm, suicide and also, it's just hard to see your kid being miserable,” Vera told KUNC earlier this year.
During the pandemic, Vera had trouble finding a therapist who accepted insurance, had openings, and who would be a good fit for her daughter who was depressed and questioning her gender identity.
"I just remember the anxiety of being in that space of feeling like someone has got to help us. But who? Where are they?” Vera said.
Over the past few months, we have been reporting on the barriers residents face in getting help, despite laws in place to ensure insurance coverage. Here’s what you need to know about mental health parity laws.
What is mental health parity?
Federal and state parity laws require insurance companies to cover behavioral health services such as therapy in the same way that they cover physical health services such as doctor’s appointments. Parity laws prohibit insurance carriers from being more restrictive based on measures like copays and the number of covered appointments.
With some exceptions, mental health services are a covered benefit for most Coloradans with insurance. Still, residents regularly have trouble getting care.
“It can be really, honestly be like climbing Everest twice without oxygen to go from the moment of realizing that you need help and then within seven calendar days walking in or signing on to your first therapy session using your insurance,” said Cara Cheevers, the head of behavioral health at Colorado’s Division of Insurance, in reference to getting care within a week, as required by regulation.
If parity laws exist, why is getting help so hard?
Several reasons. One is a widespread problem with inaccurate provider directories known as "ghost networks". This is when an insured person pulls up a list of in-network therapists but then is unable to connect with them over phone or email.
“You might find out that person is no longer in-network,” Cheevers said. “It may be that they're not even in your state. It may be that they're not even real. It might be that you might have the same person duplicated five or 10 times, and they're not taking new patients.”
Colorado regulation does require insurance companies to regularly update their directories. The state’s Division of Insurance is currently working to determine the scope of ghost networks here.
Plus, in many rural communities, Colorado has a true shortage of therapists, counselors, psychologists and other behavioral health providers. But perhaps the even bigger issue is the lack of providers who take insurance. In some cases, insurance reimbursement rates are too low. For many, the process of getting in-network, called credentialing, takes too long — sometimes up to four months.
“It's too hard to figure out how to get in-network. There are challenges with the administrative burden of taking commercial insurance. Some providers will say it's not worth the extra lift to do so,” Cheevers said.
For now, residents who can afford to pay out-of-pocket do, while others try to figure out a way to get in-network care or go without help entirely.
Over the summer, the Division of Insurance asked companies to speed up and simplify the process. There is also an effort to get more pre-licensed providers in the mix and covered by insurance to ease the workforce shortage.
How does Colorado enforce its parity laws?
In 2019, lawmakers here passed a bill that expanded parity and gave the Division of Insurance more power. That’s when Cara Cheevers’ job was created. Her department now has three employees.
The Division of Insurance enforces parity proactively through actions such as yearly reviews of co-pays and pharmacy benefits. They issue regulations and fines. But enforcement without sufficient consumer complaints can be tricky; last year, the division only received 48 complaints related to behavioral health.
“It takes a lot of work and it takes a lot of time and a lot of times policy change is not sexy either, right? Like to say, ‘Oh we amended this regulation and now we're collecting data on reimbursement rates’ and to someone experiencing a crisis or someone who's struggling to get out of bed, that doesn't land,” Cheevers said. “That is, I think, the inherent just push and pull of systems work and systems change.”
Are Coloradans aware that because of parity laws, mental heath services should be covered?
Struggling to find care is a common experience but many people are unaware of their consumer rights. According to the most recent Colorado Health Access Survey, 70% of people who went without needed care said they did not think insurance would cover it.
If you are unable to get covered treatment within the specified timeframe, your insurance company should approve that treatment with an out-of-network provider, in writing.
Some help is out there. For insurance questions and to file a complaint, the Division of Insurance has a consumer services team that is reachable over the phone or email.
Colorado also has an independent behavioral health ombudsman who residents can contact for help navigating the system.
KUNC is part of the Mental Health Parity Collaborative, a group of newsrooms that are covering stories on mental health care access and inequities in the U.S.. The partners on this project include The Carter Center, The Center for Public Integrity, and newsrooms in select states across the country.
