• Yona Remer

How to Find a Therapist in Santa Monica—That Your Insurance Will Cover

When it comes to mental health access, millions of Americans fight an uphill battle in finding appropriate therapy. If widespread stigma wasn’t enough, Americans also have to contend with the challenges of utilizing their health insurance. Technically speaking, parity laws require health insurance companies to provide access to mental health coverage on the same terms as that of routine medical coverage. But, if you or a loved one has ever had to find an in-network mental health specialist, you’re probably familiar with the widespread insufficiency of insurance networks.

To add insult to injury, the average health insurance premium in California for an individual is $726 per month and over $1,700 per month for families-- representing 14% and 27% of earnings respectively. For that reason, Hubpsych is committed to holding health insurance companies accountable for their poorly-maintained local Southern California networks. Hubpsych will be publishing regular reports for each neighborhood across Los Angeles regarding the sufficiency of their network, in hopes of promoting awareness and mental health reform.

Therapists In Santa Monica

With approximately 100,000 people, Santa Monica is one of the more densely populated neighborhoods in Southern California and is also in the top quartile in wealth. In a given year 1 in 5 people in Santa Monica will experience a mental health issue—or 20,000 people. Among those 20,000 people there is exceptionally broad diversity of backgrounds, ages, disorders—each of which requires a different therapeutic approach and in some instances well-trained mental health specialists. For the three largest health insurance networks in California, each has the following number of Santa Monica-based providers.

With not more than 50-60 in-network providers in the entirety of the Santa Monica area, it is fairly obvious to see how lacking insurance panels are. With less than 60 unique in-network mental health providers among the three largest insurance providers, Anthem, Blue Shield of California, and Health Net leave their members badly in need. When it comes to Blue Shield and their third party mental health network (Magellan), members are left to navigate a directory without providers addresses and little sense for who is actively accepting Blue Shield of California policies. Altogether, it seems that each insurance company has roughly a mental health specialist per over 200 members—a number that clearly fails to meet the community’s needs.

It is also worth noting that these numbers do not even reflect the specialist requirements of many mental health diagnosis. Eating Disorders, Obsessive Compulsive Disorder, Schizophrenia and many others require highly trained and specialty clinicians that are not properly reflected in the insurance panels. This lack of access is largely driven by unsustainably low rates that insurance companies offer providers and maintains a network in which members can not fully utilize their mandated benefits. With reimbursements as low as $65 per hour of psychotherapy, Marriage & Family Therapists, Licensed Social Workers and Psychologists can not build sustainable and effective practices.

So, the next question then is: what is a consumer to do? For starters, those with PPO insurance policies are encouraged to maximize their benefits. Submit superbills frequently and appeal denials or underpayments, whenever possible. These submitted claims will go a long way to ensuring that insurance companies are held accountable for mental health services-- which are essential.

Moreover, if a client has an HMO or would like to work within a network, look into a Single Case Agreement as an option. Single Case Agreements (SCAs) are exceptions granted by insurance companies to contract on a case-by-case basis with providers where there is clearly an insufficient network. Members can initiate one by expressing the lack of access to speciality mental health care in their network. Lastly, consumers can begin demanding more accountability for their insurance. If you have an employer-based policy, speak to your Human Resources representative about your mental health benefits and which insurers and plans have the most robust coverage and networks.

For this reason, Hubpsych is working to challenge the status quo. Our platform is designed to collaborate with a diverse range of highly specialized mental health practitioners throughout Los Angeles. At the same time, we’re working to help clients maximize their out of network insurance benefits and identify in-network therapeutic options to best meet the unique needs of our clients. We are actively working to tailor a local network of mental health specialists with a broad degree of specialities—use our therapist search tool to find the right one for you.

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