The COVID-19 pandemic has hit kids hard. Their mental well-being was already tenuous before the pandemic, and COVID-19 has only exacerbated what was already a crisis of anxiety, depression, and suicidality among youth. Getting treatment for adolescents with mental health issues was difficult prior to the pandemic. We have recently published a study in Psychiatric Services that shows that currently obtaining an appointment with a child psychiatrist is very difficult in general, and nearly impossible when trying to do so with Medicaid.
In our study, we used the Blue Cross Blue Shield (BCBS) online database of in-network providers. We identified and called between 82 and 120 psychiatrists in Chicago, Houston, and Los Angeles. This database was used because BCBS is the biggest provider of health insurance in Illinois, Texas, and California. We posed as parents of a 10-year-old child with either BCBS PPO insurance, Medicaid, or as being willing to pay out of pocket.
Out of the 322 psychiatrists we called, we were only able to obtain appointments 11 percent of the time. Although obtaining any appointment at all was difficult, it was even more challenging to get an appointment—whether in person or virtual—using Medicaid compared to either BCBS or self-pay. This finding is particularly concerning because the populations that have been hit the hardest by COVID—namely minorities and those who are poor—are the same groups that are most likely to utilize Medicaid.
Furthermore, for the few available appointments, the average wait time was over a month. Concerningly, almost one-fifth of the phone numbers were wrong, and one-quarter of psychiatrists were not accepting new patients.
These findings add to the existing evidence that accessing needed mental health care is difficult, and merely having insurance is not enough to guarantee access to outpatient psychiatric care. They poignantly illustrate how difficult it can be for pediatric patients to obtain the mental health care they need.
When a child needs inpatient psychiatric care, the situation is equally dire because insurance companies generally require clinicians to obtain prior authorizations before admitting patients to inpatient facilities. In a study conducted several years ago in a children’s hospital, one of us (JWB) found that clinicians spent an average of one hour on the phone with insurers to obtain these authorizations. It is likely that insurance companies hope the time required for authorization will dissuade clinicians from seeking to admit patients to psychiatric facilities. If that is the case, the requirement to obtain prior authorizations would essentially amount to rationing psychiatric care based on the “hassle factor.”
The difficulties in obtaining needed child psychiatric care have serious implications for the mental health and well-being of children and adolescents. Mental disorders already rank as the leading cause of disability in the United States, and the pandemic has only intensified this pre-existing crisis. Without timely access to appropriate care, their conditions can worsen, leading to prolonged suffering, diminished productivity, and even suicide.
Insurance companies need to do their part and ensure the accuracy of their provider databases, as incorrect information can hinder families’ efforts to find care. They also need to eliminate the requirement for prior authorizations when suicidal or homicidal children need to be admitted to psychiatric facilities. Additionally, the reimbursement rates that insurers pay for psychiatric care ought to be increased, so that more psychiatrists would be willing to accept insurance. By taking these proactive measures, insurance companies could help alleviate the burden on families seeking mental health care for their children.
Moreover, efforts should be made to increase the number of child psychiatrists and integrate psychiatric care into primary care settings to enhance accessibility.
Addressing this crisis requires collaborative efforts from insurance companies, health care providers, policymakers, and society as a whole. By prioritizing mental health care for children and implementing effective strategies, we can ensure that children receive the support and treatment they need to lead healthy and fulfilling lives.
Victoria Chen is a medical student. J. Wesley Boyd is a psychiatrist.
