Insurance obstacles hinder psychologists from addressing mental health crisis

Although demand for mental health treatment remains high, administrative and financial barriers are preventing many psychologists from participating in insurance networks, according to the American Psychological Association’s 2024 Practitioner Pulse Survey.

Barriers by many insurance companies can make it more difficult for psychologists to remain in-network and for patients to access the care they need, exacerbating the ongoing mental health crisis.

This annual survey, which was conducted among 853 psychologists in September 2024, by APA and its companion organization APA Services Inc, found that around a third (34%) of psychologists weren’t accepting any form of health insurance, with nearly half of them (48%) saying they had participated in insurance networks in the past. Only 18% of psychologists said that they had never participated with insurance in their careers.

Among psychologists who quit insurance networks or never participated with insurance, more than eight in 10 (82%) said that insufficient reimbursement rates were a primary obstacle to taking insurance.

Additionally, 62% reported administrative challenges, such as pre-authorization requirements and audits as barriers to their participation. And more than half of this group (52%) pointed to concerns about payment reliability, including delays in payment and refund demands as barriers.

“We’ve heard from individual psychologists who have been pressured by insurance companies to cut off care to patients, including those with serious mental illness or at risk for suicide,” said APA Chief Executive Officer Arthur C. Evans Jr., Ph.D.

“Psychologists have spent countless hours tracking down missed payments and lost thousands of dollars in audits that may take place months or years after service is provided. These insurance hurdles are not only hurting psychologists—they are hurting the patients who need care the most.”

These findings come alongside indications that demand for mental health treatment continues to soar. More than half (53%) of psychologists said that they didn’t have any openings for new patients. And a similar number (51%) reported an increase in symptom severity among patients along with more than four in 10 (44%) reporting that their patients have needed an increased duration of treatment.

“Psychologists want to work with insurance providers to provide access to patients who must rely on their insurance for their mental health needs. But when a company’s reimbursement rates are too low and the administrative burdens are too high, some psychologists have had to make difficult choices about whether to work with those insurers,” said Lynn Bufka Ph.D., APA’s head of practice.

“Those insurance companies could fix this problem and increase access to mental health treatment for patients by simply paying psychologists fairly and reducing the unnecessary administrative burdens that hinder their ability to provide care.”

Methodology

The APA Practitioner Pulse Survey series has been conducted annually since 2020. Originally intended to track changes in psychological practice during the COVID-19 public health emergency, the survey has since been revised to track changes in the workforce after the emergency expired in May 2023.

The survey was conducted online and distributed via email. It used a probability-based random sample, giving all potential survey invitees an equal opportunity to be selected for the survey. Invitations were sent to a sample of 35,000 on Sept. 4, 2024, and several reminder emails were sent to encourage survey completion.

The survey closed on Sept. 30, with a completion rate of 3.1%. A full methodology is available.