Millions of Americans are seeking therapy, counseling, and psychiatric treatment. Depression, anxiety, substance use, and suicide rates have all climbed dramatically since 2020. And just when people need help the most, big insurers are turning their backs.
Mental health care is supposed to be covered equally under federal law. The 2008 Mental Health Parity and Addiction Equity Act was meant to guarantee that mental health benefits are treated with the same importance as physical health. In practice, insurers have found loopholes, imposed restrictions, and slashed reimbursement so badly that providers aren’t walking away from networks by choice—they’re being shoved out the door.
Many simply can’t afford to accept insurance’s rock-bottom rates and still keep their practices afloat. This is a hard truth that translates into higher costs and reduced access for patients.
Insurers routinely underpay therapists and psychiatrists:
- Behavioral health visits are reimbursed 20.8% less than primary care visits (Milliman, 2019)
- Out-of-network utilization rates for behavioral health are 5.1x higher than for medical/surgical services—largely due to underpayment and narrow networks.
And providers are opting out:
- More than 60% of psychiatrists don’t accept commercial insurance (JAMA Psychiatry, 2014)
- In contrast, just 11% of other physicians opt out.
- Unsustainable payments and widespread clinician burnout make it nearly impossible for many to stay in-network.
Wreaking havoc for patients:
- Waiting lists for mental health services stretch months.
- People in crisis have limited options, often ending up in ERs because there are no available beds or in-network providers to take them.
Meanwhile, insurers report record earnings. UnitedHealth Group made $22 billion in profit in 2023. Cigna and Elevance weren’t far behind. Somehow, there’s always money for shareholder buybacks—just not for the therapist down the block.
And still, mental health services are now one of the most requested workplace benefits, prompting major investments in employee assistance programs, virtual therapy apps, and on-site counseling. But even these efforts often run into the same roadblock: insurers lowball rates or bury access in red tape.
Providers are the last line of defense for patients, and as more health systems invest in top-of-funnel behavioral health services, the payor problem can’t be ignored. Insurers are not just neglecting mental health—they are actively making it harder to treat. Inadequate networks, low reimbursement, and administrative red tape don’t just delay care; they push patients into crisis and cost hospitals down the line.
The longer health systems wait to demand accountability for real parity in mental health, the more burden it creates within the system. Patients deserve access. Providers deserve fair pay. And mental health deserves more than empty promises.
