Illinois is facing a mental health crisis, with rising rates of suicide, substance use disorder and depression since the pandemic. However, many people in the state with mental health issues have difficulty finding a therapist covered by their insurance.
According to the U.S. Department of Health and Human Services, Illinois ranks 35th among U.S. states and territories in meeting the mental health care needs of its population, with only about 21% of needs being met.
Jason Best, a mental health professional who runs Best Therapies, one of the largest practices in Chicago with a branch in Hyde Park at 5113 S. Harper Ave., told the Herald that this is not due to a shortage of practicing therapists in Illinois, the claim made by insurance companies. Healthy.
Instead, Best said, the low prices that health insurance companies pay to mental health practitioners cause many to conclude that it is not financially feasible to join the insurance network, forcing their patients to choose between paying for treatment out of pocket or stopping receiving care entirely.
But a new legislative effort making its way through the state House looks to change that calculus by increasing the minimum rates therapists are paid by insurance companies.
According to a 2017 study that looked at gaps in the health insurance market, state plan networks included only 11.3% of all mental health care providers on average, about half of primary care providers.
Although the headache of fighting insurance companies for better payment rates has plagued Best during his 20-plus year career as a therapist, he and his practice continue to accept patients with many different forms of insurance (or even no insurance) as a matter of equity.
“One of my oldest clients is someone I've been seeing on a sliding scale for years because their insurance pays almost nothing,” he said.
Insurers are “definitely trying to reduce their payments for services that are very popular,” Best continued, all while generating windfall profits.
UnitedHealth Group, the parent company of UnitedHealth of Illinois, reported earnings of $6.06 billion in the third quarter of 2024, an increase of $260 million from the same quarter in 2023. In the same year, Health Care Service Corporation, the parent company of Blue Cross Blue Shield of Illinois generated record revenues of $54 billion and distributed multi-million-dollar compensation packages to top executives.
Insurers' practice of delaying or denying claims for questionable reasons also pushes mental health professionals to provide in-network care, Best said.
Best once worked as a therapist for someone working for UnitedHealth Care as an insurance claims auditor, who he said “suffers from PTSD when asked to deny people who they know need consent.”
“They were doing the right thing, and then they felt so bad,” he continued.
Many solo or small therapy practices do not have the time or stamina to dispute claims, which may involve sitting for hours trying to speak with an insurance company representative. Instead, they give up or refuse to accept insurance.
One very promising young color therapist at Best Clinic has left the profession altogether after several inexplicable delays in payments from insurance companies. Best was very sad when they told him they were resigning because it was so stressful not knowing when or if the insurance companies would pay out.
“I need something more stable,” they told him.
Despite their financial strength, Best said Illinois' major insurers haven't changed their rates significantly in more than a decade.
Just last week, Best contacted an insurance company to negotiate a better rate after noticing they were paying much less than other companies.
“You're definitely at the bottom,” he told them. “Can you please do a raise?” he asked.
The company responded that its algorithm calculated that they were paying exactly the correct amount.
“Obviously that's not the case, because you guys are the worst,” Best replied.
Aetna Better Health in Illinois reduced couples therapy rates by 20%, he said.
“We have the option of either telling the 200 of our customers who have Aetna that we won't be in network anymore, which would be tough for them, or we accept fewer, and then we have some therapists,” Best said. Saying, 'Well, I'm not going to do husbands because it doesn't pay enough.'”
CVS Health, Aetna's parent company, did not directly respond to the Herald's specific questions about their pay rates. Instead, their spokesperson issued a written statement, saying:Aetna Better Health of Illinois follows the Illinois Department of Health Care and Family Services guidelines, which set reimbursement rates for services provided to Medicaid beneficiaries in the state.
(While the prices paid by Medicare and Medicaid are a matter of public record, the prices paid by private insurers are not.)
But a recently proposed state law, HB4475, co-sponsored by local state Sen. Robert Peters (D-13), seeks to correct the imbalance in payment rates by forcing insurers to pay equal to or greater than 141% of the Medicare reimbursement rate. For the same mental health services.
“It's really one of the biggest bills that have come out in the mental health space since I've been practicing,” Best said.
The bill would also shorten the timeline for mental health providers to obtain approval to communicate with an insurance company from as little as four to 60 days; Requires them to cover same-day mental health and substance use disorder services, as well as 60-minute therapy sessions, without requiring additional documentation; And only allow mental health professionals with a master's degree in social work to bill under the supervision of a fully licensed therapist while working toward their license.
In mid-April, the Illinois House of Representatives passed the bill with bipartisan support, by a vote of 86 to 20 against. Now, Best said, insurance companies are preparing for a fight to block the bill.
In addition to Peters, who could not be reached for comment by press time, the bill has the support of 28 of his colleagues, including two Republicans. (The Illinois Senate has 59 seats, so 30 votes constitute a majority.)
A Senate hearing on the bill has not been scheduled, and with the Senate veto session ending last week, on November 21, senators will not return to Springfield until mid-January 2025.
The best hopes are that the bill will reach Pritzker's desk sometime in the new year.
Although Illinois Governor J.B. Pritzker has not commented publicly on whether he supports the bill, he has previously issued executive orders and signed bills targeting large insurance providers. After issuing an executive order requiring insurers to reimburse health care providers for telehealth at rates paid as in-person care, he signed a law that creates parity between telehealth rates for primary care providers and mental health practitioners.
“A lot of therapists were calling people, eavesdropping on their state senators, congregating on social media,” Best said.
“So, I know people are invested,” he continued. “I hope that's enough.”
