Getting the care you need for mental health and substance use disorders shouldn’t be emotionally draining or time consuming. Yet that’s exactly what some of you told us in a recent study we commissioned.
Here’s what we heard from one member:
I also tried calling the number on the back of my insurance card. Was given a list. None of those therapists were accepting new patients, and there was a mixture of therapists that just never contacted me back. And I would like to reiterate that it’s tragic, that there seem to be no offerings for people who are low and need critical, immediate help.
We feel this is unacceptable and we’re taking action to help improve how you access quality, timely, and affordable behavioral health services.
What You Told Us About Access and Your Experience
CalPERS partnered with the UC Davis Center for Healthcare Policy and Research on the Behavioral Health Access Project, which surveyed CalPERS members enrolled in our health plans from January 2020 to mid-October 2021.
Of the more than 10,000 CalPERS members who responded to the survey, more than half considered seeking behavioral health care. Of those who received care:
- 61% were unable to get an in-plan appointment within two weeks.
- 46% identified difficulty finding a clinician as the biggest barrier to care.
- More than half received care outside their health plan.
- LGBTQ+ members were more likely to report a lack of timely access to care.
UC Davis researchers then conducted focus groups to hear stories firsthand from members about their behavioral health needs and experience accessing services. Focus group participants echoed what is heard at the national level:
- There’s a lack of clinicians with available appointments, often leading members to pay out-of-pocket for clinicians outside of their insurance.
- Provider directories are not current, and members often found clinicians were not accepting new patients or, in some cases, were not in the plan network.
- There’s a lack of clear information about health plan benefits, including confusion about what services the plans will and will not cover, and the costs such as copays.
- Navigating the insurance bureaucracy to obtain services was emotionally draining and time-consuming.
- Barriers to accessing behavioral health services seemed greater than barriers to accessing physical health care.
What We’re Doing to Help You Access Behavioral Health
CalPERS has long prioritized behavioral health. The pandemic, clinician shortages, and an increase in the rates of mental illnesses such as depression and anxiety have only amplified our need to do more, quickly.
We’re taking important steps to make sure you can access quality behavioral health services when you need them:
- We’re requiring your health plan mail or email you materials with clear information about:
- Behavioral health benefits available to you and your family, and specifics on how you access them
- What’s covered by your health plan
- Who to contact for help if you’re having issues getting a timely appointment
- Additional resources available from the plan such as apps, helplines, or navigator programs
- We’re requiring plans to keep their behavioral health network provider lists up to date, including an indication of whether providers are taking new patients or not.
- On our end, we’re going to require the plans to report to us on metrics around quality and access for the behavioral health services they’re providing.
- We’re working with the plans to add more behavioral health clinicians to their networks.
Look for an email or mail from your health plan in the next several weeks and keep it handy.
Bottom Line: How Will You Benefit?
You’ll soon receive information from your health plan either via email, U.S. mail, or even both. Keep a look out for this important information that will help guide you and your family members in getting the care you need when you need it. The information will include the benefits covered through your health insurance.
Keep in mind that California state law requires coverage for behavioral health conditions for adults and youth for anxiety, bipolar and eating disorders, schizophrenia, depression, substance use conditions, and post-traumatic stress disorder. And when medically necessary, your plan must cover sessions with a therapist, hospital and clinic settings, and medication to manage your condition.
The law also mandates that if you cannot find an appropriate behavioral health provider in-network, the health plan must arrange and pay for out-of-network services at no additional cost to you. This law applies to all plans regulated by the California Department of Managed Health Care, which include CalPERS HMO and EPO plans; exclusions may apply to the Preferred Provider Organization plans.