New CA law takes aim at long wait times for mental health care : Shots

When Greta Christina heard that Kaiser Permanente mental health clinicians were staging a protest on Oct. 13, 2019, over long wait times for therapy, she made her own sign and showed up to support them. She’s had to wait up to six weeks between therapy appointments for her depression.

Ingrid Nelson


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Ingrid Nelson


When Greta Christina heard that Kaiser Permanente mental health clinicians were staging a protest on Oct. 13, 2019, over long wait times for therapy, she made her own sign and showed up to support them. She’s had to wait up to six weeks between therapy appointments for her depression.

Ingrid Nelson

When Greta Christina fell into a deep depression five years ago, she called up her therapist in San Francisco — someone she’d had a great connection with when she needed therapy in the past. And she was delighted to find out that he was now “in network” with her insurance company, meaning she wouldn’t have to pay out of pocket anymore to see him.

But her excitement was short-lived. Over time, Christina’s appointments with the therapist went from every two weeks, to every four weeks, to every five or six.

“To tell somebody with serious, chronic, disabling depression that they can only see their therapist every five or six weeks is like telling somebody with a broken leg that they can only see their physical therapist every five or six weeks,” she says. “It’s not enough. It’s not even close to enough.”

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Then, this summer, Christina was diagnosed with breast cancer. Everything related to her cancer care — her mammogram, biopsy, surgery appointments — happened promptly, like a “well-oiled machine,” she says, while her depression care stumbled along.

“It is a hot mess,” she says. “I need to be in therapy — I have cancer! And still nothing has changed.”

A new law signed by Gov. Gavin Newsom in October aims to fix this problem for Californians. Senate Bill 221, which passed the state Legislature with a nearly unanimous vote, requires health insurers across the state to reduce wait times for mental health care to no more than 10 business days. Six other states have similar laws limiting wait times, including Colorado, Maryland, and Texas.

Unequal access to behavioral health care is pervasive

Long waits for mental health treatment are a nationwide problem, with reports of patients waiting an average of

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Surprise medical bills are the target of a new law. Here’s how it works : Shots

The No Surprises Act is intended to stop surprise medical bills. It could also slow the growth of health insurance premiums.

J. Scott Applewhite/AP


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J. Scott Applewhite/AP


The No Surprises Act is intended to stop surprise medical bills. It could also slow the growth of health insurance premiums.

J. Scott Applewhite/AP

Patients are months away from not having to worry about most surprise medical bills — those extra costs that can amount to hundreds or thousands of dollars when people are unknowingly treated by an out-of-network doctor or hospital.

The No Surprises Act — which takes effect Jan. 1 — generally forbids insurers from dropping such bills on patients and, instead, requires health care providers and insurers to work out a deal between themselves.

Some observers have speculated that the law will have the unintended consequence of shifting costs and leading to higher insurance premiums.

Many policy experts told KHN that, in fact, the opposite may happen: It may slightly slow premium growth.

The reason, said Katie Keith, a research faculty member at the Center on Health Insurance Reforms at Georgetown University, is that a new rule released Sept. 30 by the Biden administration appears to “put a thumb on the scale” to discourage settlements at amounts higher than most insurers generally pay for in-network care.

That rule, which provides more details on the way such out of network disputes will be settled under the No Surprises Act, drew immediate opposition from hospital and physician groups. The American Medical Association called it “an undeserved gift to the insurance industry,” while the American College of Radiology said it “does not reflect real-world payment rates” and warned that relying on it so heavily “will cause large imaging cuts and reduce patient access to care.”

Such tough talk echoes comments made while Congress was hammering out the law.

Here’s how the law will work and how it might affect insurance premiums and the health care industry.

Sending unsettled bills to arbitration

The No Surprises Act takes aim at a common practice: large, unexpected “balance bills” being sent to insured patients for services such as emergency treatment at out-of-network hospitals or via air ambulance companies. Some patients get bills even after using in-network facilities because they receive care from a doctor there who has not signed on with an insurer’s network.

Patients were caught in the middle and liable for

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