For Chicago therapists, offering mental health care services in-network doesn’t always pay | Evening Digest

Illinois is facing a mental health crisis, with rising rates of suicide, substance abuse disorder and depression since the pandemic. Yet many people in the state struggling with mental health issues have trouble finding a therapist covered by their insurance.

According to the U.S. Department of Health & Human Services, Illinois ranks 35th among U.S. states and territories at meeting its residents’ mental health care needs, with only about 21% of needs being met.

Jason Best, a mental health professional who runs Best Therapies, which is one of the largest practices in Chicago with a Hyde Park branch at 5113 S. Harper Ave., told the Herald that’s not because of a shortage of practicing therapists in Illinois, a claim advanced by health insurance companies. 

Rather, Best said, the low rates health insurance companies pay to mental health practitioners cause many to conclude it’s not financially viable to join an insurance network, forcing their patients to choose between paying for therapy out of pocket or stop receiving care entirely. 

But a new legislative effort wending its way through the statehouse is looking to change that calculus by increasing the minimum rates for therapists paid by insurers.

According to one study from 2017 looking at gaps in the Health Insurance Marketplace, state-plan networks included only 11.3% of all mental health care providers on average, about half that of primary care providers.

Although the headache of fighting insurance companies for better payment rates has worn on Best during his 20-plus year career as a therapist, he and his practice continues to accept patients with many different forms of insurance (or even without insurance) as a matter of equity.

“One of my longest standing clients is someone that I’ve been seeing on a sliding scale for years because their insurance pays almost nothing,” he said.

Insurance companies, Best continued, “are absolutely trying to minimize their payment for services that are very popular,” all while taking in windfall profits. 

UnitedHealth Group, the parent company of UnitedHealth of Illinois, reported $6.06 billion in profit in the third quarter of 2024, a $260 million increase from the same quarter in 2023. That same year, Health Care Service Corporation, the parent company of Blue Cross Blue Shield of Illinois, raked in record revenues of $54 billion and shelled out multi-million dollar compensation packages to its top-executives.

Insurers’ practice of delaying or denying claims for dubious reasons also drives mental health professionals from providing in-network care, Best said. 

Best once worked as a therapist for someone working at UnitedHealth Care as an insurance claims reviewer, who he said was “suffering PTSD from being told to deny people they knew they needed to approve.” 

“They were doing the right thing, and then feeling really awful,” he continued.

Many solo or small therapy practices don’t have the time or stamina to dispute claims, which can involve sitting on hold for hours trying to speak with an insurance company representative. Instead, they give up or refuse to accept insurance.

One very promising young therapist of color at Best’s practice left the profession entirely after a few inexplicable delays in payments from insurance companies. Best was heartbroken when they told him they were resigning because it was too stressful not knowing when or if the insurance companies would pay up. 

“I need something that’s going to be more stable,” they told him.

Despite their financial strength, Best said the major insurance companies in Illinois have not substantially changed their rates in more than a decade. 

Just last week, Best called one insurer to negotiate for a better rate after noticing that they paid far less than other companies. 

“You’re definitely at the bottom,” he informed them. “Could you please do an increase?” he asked.

The company responded that their algorithm calculated that they were paying exactly the correct amount. 

“It clearly isn’t,” Best replied, “because you guys are the worst.”

Aetna Better Health of Illinois, he said, even dropped their rates by 20% for couples’ therapy.

“We have the option of either telling 200 of our clients who have Aetna that we’re not going to be in network anymore, which would be brutal for them,” Best said, “or we accept less, and then we have some therapists saying, ‘Well, I’m not going to do couples work because it doesn’t pay enough.’” 

CVS Health, the parent company of Aetna, 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 guidelines of the Illinois Department of Healthcare and Family Services, which establishes reimbursement rates for services provided to Medicaid beneficiaries in the state.”

(While the rates paid by Medicare and Medicaid are a matter of public record, the rates paid by private insurance companies are not.)

But a recently proposed state law, HB4475, co-sponsored by local state Sen. Robert Peters (D-13th) seeks to rectify the imbalance in payment rates by forcing insurance companies to pay equal to or greater than 141% of the Medicare reimbursement rate for the same mental health services. 

“It really is one of the biggest bills to be coming out in mental health since I’ve been practicing,” Best said.

The bill would also shorten the timeline for mental health providers to receive approval to be in-network with an insurance company from upwards of four to 60 days; require that they cover of same-day mental health and substance use disorder services, as well as 60-minute therapy sessions without asking for additional documentation; and allow mental health professionals with only a masters in social work degree to bill under the supervision of a fully licensed therapist while working toward their own licensure.

In mid-April, the Illinois House of Representatives passed the bill with bipartisan support, 86 votes in favor to 20 against. Now, Best said, the insurance companies are gearing up for a fight to block the bill. 

In addition to Peters, who couldn’t be reached for comment as of 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 yet been scheduled, and with the Senate’s veto session ending last week, on November 21, senators are not due back in Springfield until mid-January 2025. 

Best hopes the bill reaches Pritzker’s desk sometime in the new year.

Although Illinois Gov. J.B. Pritzker has not publicly commented on whether he supports the bill, he has previously issued executive orders and signed into law bills aimed at major insurance providers. After issuing an executive order requiring insurers to reimburse health care providers for telehealth at the payment rates as in-person care, he signed off on a law creating parity between telehealth rates for primary care providers and mental health practitioners.

“A lot of my therapists have been calling people, bugging their state senators, and there’s rallying around on social media,” Best said. 

“So, I know people are invested,” he continued. “I’m hoping that it’s enough.”