Illinois Mental Health Crisis: A Fight for Equitable Care
Illinois is facing a mental health emergency. Suicide rates are rising, and cases of substance abuse disorder and depression are surging in the wake of the pandemic. Yet, countless Illinois residents struggling with these challenges face a difficult obstacle: finding affordable mental health care that is covered by their insurance.
The state ranks 35th in meeting its residents’ mental health needs, according to the U.S. Department of Health & Human Services. Only about 21% of the state’s mental health care needs are being met.
Jason Best, a leading mental health professional and owner of Best Therapies, one of Chicago’s largest practices, argues that the problem stems not from a shortage of therapists but from exploitative practices by insurance companies. While insurers claim a lack of therapists drives the shortage, Best maintains that their low reimbursement rates make it financially unsustainable for therapists to join insurance networks. This forces patients to either pay exorbitant out-of-pocket fees or abandon treatment altogether.
"One of my longest standing clients is someone that I’ve been seeing on a sliding scale for years because their insurance pays almost nothing," Best shared.
Best emphasizes that insurance companies are actively trying to minimize payments for mental health services, even while reaping immense profits. UnitedHealth Group, parent company of UnitedHealth of Illinois, publicized a profit of $6.06 billion in the third quarter of 2024, a $260 million increase from the same period in 2023. Meanwhile, Health Care Service Corporation, parent company of Blue Cross Blue Shield of Illinois, earned record revenue of $54 billion in 2023 and awarded multi-million dollar compensation packages to its executives.
Insurance companies further exacerbate the issue by delaying or denying legitimate claims, driving many therapists away from in-network care. Best described a former employee of UnitedHealth Care who worked as an insurance claims reviewer and suffered PTSD from being instructed to deny claims they knew should be approved.
"They were doing the right thing," Best said, "and then feeling really awful."
These practices have led many therapists, particularly those in solo or small practices, to abandon insurance networks altogether. They simply don’t have the time or resources to fight insurance companies for rightful payments. As a result, many talented therapists, discouraged by the system, leave the profession entirely. Best heartbreakingly recounted losing a promising young therapist of color who couldn’t bear the stress of unpredictable insurance payments, leaving the field for more stable work.
Despite their immense profits, major Illinois insurers haven’t meaningfully adjusted their reimbursement rates in over a decade. Best recently attempted to renegotiate with an insurer whose rates he found significantly lower than other companies. He was met with a response based on an algorithm that claimed their reimbursement rate was "exactly correct."
"It clearly isn’t," Best countered, "because you guys are the worst."
Aetna Better Health of Illinois, according to Best, even slashed their couples therapy rates by 20%.
"Due to these changes, we have the option of either telling 200 of our clients who have Aetna that we’re not going to be in network anymore, or we accept less, and then we have some therapists saying, ‘Well, I’m not going to do couples work because it doesn’t pay enough.’"
While Aetna did not directly address the issue of low reimbursement rates, their spokesperson issued a statement claiming adherence to guidelines set by the Illinois Department of Healthcare and Family Services for reimbursing Medicaid beneficiaries. Medicare and Medicaid reimbursement rates are public record, while rates paid by private insurers remain confidential.
However, a glimmer of hope has emerged with the introduction of a new bill, HB4475, co-sponsored by State Sen. Robert Peters, aimed at addressing this imbalance.
This bill proposes mandating that private insurers pay therapists equal to or greater than 141% of the Medicare reimbursement rate for the same mental health services.
HB4475 also intends to expedite the approval process for therapists seeking to join insurance networks, require coverage for same-day mental health and substance use disorder services, mandate coverage for 60-minute therapy sessions without unnecessary documentation, and allow master’s level social workers to bill under the supervision of licensed therapists while pursuing their licensure.
The bill enjoyed bipartisan support in the Illinois House of Representatives, passing with a vote of 86 to 20 in mid-April. However, big insurance companies are expected to make a strong push against the bill. Mental health advocates remain hopeful, despite the veto session’s conclusion and the Senate’s impending return in January 2025.
“[A] lot of my therapists have been calling people, bugging their state senators, and there’s rallying around on social media,” Best said.
“So, I know people are invested. I’m hoping that it’s enough.”
Governor J.B. Pritzker has yet to publicly announce his stance on the bill. However, his previous actions, including an executive order ensuring equal telehealth reimbursement rates, and signing off on a law striving for payment parity between telehealth rates for primary and mental health practitioners, hint at his potential support.
