Navigating the Complexities of Therapy Insurance Denials
As a psychiatrist and psychoanalyst, I, Grant Hilary Brenner MD, DFAPA, have witnessed firsthand the profound impact insurance barriers have on patients’ mental health treatment. Unfortunately, the process of seeking and securing insurance coverage for therapy is often fraught with obstacles, causing undue stress and potentially hindering recovery. While insurance companies cite the need to verify necessary care, the reality too often disrupts the critical clinician-patient relationship. It’s a complex landscape, further complicated by mental health stigmas, a lack of parity between mental and physical health coverage, in addition to differences in business units used for physical versus mental healthcare.
Patients with good insurance coverage regularly face frustrating hurdles, including:
- Endless phone calls
- Inconsistent representatives
- Missed callbacks
- Denials despite meeting coverage criteria
- Lengthy response times
- Reviews by questionably qualified clinicians
Clinicians are also often blocked by the process of getting credentialed to be in-network. These delays cause therapy patients to experience amplified anxiety over costs, and a de-humanizing experience that disempowers both them and their therapists. Many patients end up feeling betrayed by the system. While fraud does exist, I believe most clinicians operate with integrity.
Because I am aware of these systemic issues, I was very pleased to learn about newly available resources from Cover My Mental Health (CMMH). CMMH is a non-profit organization created by mental health advocate Joe Feldman, which aims to assist patients facing insurance obstacles to therapy.
A Conversation with Joe Feldman of Cover My Mental Health
Grant H. Brenner: Joe, thank you for the update.
Joe Feldman: Grant, thanks for having me back. Since we last spoke, Cover My Mental Health has made a number of important advancements.
Cover My Mental Health is a non-profit organization that supports patients, their families, and clinicians struggling with insurance roadblocks to accessing mental health and substance use disorder care. We offer many free and readily accessible resources.
GHB: One of these obstacles can be denials or delayed prior authorization. Clinicians are best suited to determine the care necessary for patients. After all, they are involved from initial evaluation through treatment and any developments, and ultimately recovery.
JF: Consequently, we’ve developed resources to help clinicians.
GHB: I’m familiar with “medical necessity letters.” Can you define it for readers?
JF: Medical Necessity is a legal term included within the insurance policy. It usually states coverage is for “medically necessary” care. A clinician is trained to understand and provide “safe, effective” care, using generally accepted standards.
JF: When an insurer’s standards don’t line up with clinical training, that is when we can see an obstacle. One instance I encountered years ago involved my daughter’s need for residential care, which our insurer denied. After receiving a letter from her clinician, arguing why this care was medically necessary, we sued the insurer. We won, and the court agreed the care was, in fact, medically necessary.
GHB: That sounds like a very important distinction for clinicians. What does Cover My Mental Health offer to help?
JF: We provide a template for a medical necessity letter on our website. Instructions on how to prepare the letter are included, as well as example language for the clinician to adapt, based on their patient’s circumstances.
GHB: You said there were two new developments.
JF: That’s right. In November 2024, ProPublica reported on an insurance company representative who, “would call and grill them [therapists] about why they’d seen a patient twice a week or weekly for six months.”
When I read this, I immediately thought this was a matter of determining if the frequency of therapy was medically necessary by the insurer, and/or appropriate per the clinician’s training. Expert consensus supports the value of therapy with frequency and duration to help the patient recover and maintain day-to-day functionality.
With that in mind, Cover My Mental Health also offers a template for a medical necessity letter that responds to insurer inquiries about frequency. This will be a valuable resource for clinicians.
GHB: Anything else to share?
JF: Those are the most important developments. We invite clinicians to share their experiences with insurers, particularly roadblocks they’ve encountered, and any success achieved using our available resources. People are welcome to reach out to us directly* to anonymously share their stories related to care. This will help us to better support clinicians, and improve access to patient care and insurance coverage.
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