Making Mental Health Care Accessible by Bridging the Payment Gap

From the opioid crisis to the rising suicide rate, there’s plenty of evidence that Americans lack adequate mental health care. But connecting those in need with clinicians can be challenging. For many reasons, mental health professionals are less likely to accept insurance than almost all other specialists—a 2014 study by JAMA found just 55.3% of psychiatrists accepted insurance, and reports suggest that rate may be lower today.

A 2008 parity law aimed to ensure mental health gained equal footing in payer coverage, but reality can mean low reimbursement rates and caps on the number of visits. Red tape for practitioners is a problem, too. Unlike their counterparts in cardiology or oncology, psychiatrists or counselors may still be operating in solo practices without administrative help—thus, waiting 60 days or more to be paid or spending hours on the phone with an insurers are non-starters.

So, the norm in mental health is having patients pay upfront and letting them deal with insurers after the visit. Those that are in insurance networks may only see patients for medication management—talk therapy is cash only. For too many patients, this setup is unaffordable, and mental health needs go unaddressed.

The founders of a Colorado-based company think it doesn’t have to be this way.

“We’ve been looking at the problem from 2 lenses,” said Mark Frank, West Point graduate, healthcare technology executive, and co-founder of SonderMind, which is at once a provider of behavioral healthcare and a solution for consumers frustrated by their inability to use their health coverage to see a therapist.

Frank, in an interview with The American Journal of Managed Care®, said the company seeks to address 2 issue at once: first, SonderMind uses technology to connect mental health clients with the right providers; second, it expands the number of people who can seek care, by giving providers who typically don’t take insurance the chance to offload the bureaucracy and payment delays. The company, which Frank founded in 2014 with Sean Boyd, a clinician, achieves this by doing the following:

• SonderMind works with a network of carefully screened providers who are then matched with potential clients through a platform; the algorithm addresses clinical need, location, hours of availability, and whether the therapist is approved by the client’s insurer.
• The company handles all the back-end billing with major insurers—while taking on the financial risk—so that therapists can be guaranteed reimbursement. Contracted therapists can choose payment every 2 weeks for all sessions handled through the platform; for a fee, they can be paid 24 hours after each session.

Therapists SonderMind approaches often have the same reaction to the concept, Frank said. “They think it’s too good to be true.”

While SonderMind has been growing in Colorado for several years, the guaranteed pay feature is new, Frank said. Its introduction, along with the company’s growth in Phoenix, Arizona; and Austin, Texas, means that therapists in the network “only need to worry about delivering great clinical care,” he said.

SonderMind is contracted to be paid by UnitedHealthcare, Aetna, Anthem, Kaiser Permanente, Cigna, as well as some smaller regional insurers and employer networks. The company has a National Provider Identifier or NPI number, and the company recently received its Medicare number. Typically, providers with SonderMind are paid as independent contractors, Frank said, and many still see patients outside the SonderMind network.

Building a Quality Network

While SonderMind’s quality standards are grounded in standards from the National Committee for Quality Assurance, Frank said the company has developed its own credentialing criteria over time. At this point, Frank said, one national insurer now accepts SonderMind’s process and said, “We have given you the authority to run your own credentialing process.”

Frank said that SonderMind has developed programs and certifications for therapists who work with first responders as well as those who help women with postpartum depression.

SonderMind specializes in working with therapists who are in solo or small practices—they have referrals and partnerships for other parts of the behavioral health system. As for growth, the company’s website says it has more than 200 providers and some reports say it has more than 300; Frank said since its round of financing in April 2018, the company has expanded its provider network 20-fold, and it can manage mental health needs for 25 times the population it could reach 18 months ago.

The mission, he said, is to bring mental healthcare beyond the 5% of Americans who can pay out of pocket and those in Medicaid who get limited care through public insurance.

“Right now, the middle 80% is just out of luck—if they can’t afford those out-of-pocket costs, it’s just not going to happen,” he said. And for families paying high premiums for health coverage, calling and calling trying to find an in-network provider is discouraging. It’s hard enough for many people to admit they need mental health care, Frank said. “If you’re faced with rejection over and over for something for something you don’t want to do, you just quit.”

By contrast, he said, if a population that wants to find a therapist can do so—and use insurance for the first time, “We remove those barriers make it really, really easy.”