From long waiting lists to high costs, finding a therapist in Colorado is harder than it should be

In communities across northern Colorado, people are struggling with their mental health while also struggling to get the care they need.

The problem is widespread. About a quarter of residents reported poor mental health in the latest Colorado Health Access Survey. Of the 1 in 6 Coloradans who couldn’t get the care they needed, nearly half said they had a hard time getting an appointment, while nearly 60% were concerned about cost.

Fort Collins resident Christine Vera has lived through these statistics while trying to get help for her teenage daughter over the past few years.

Her mood was extremely bad. And of course, I was worried about self-harm, suicide, and it’s also hard to see your child miserable, Vera told KUNC earlier this year.

During the pandemic, Vera had trouble finding a therapist who accepted insurance, had availability, and was a good fit for her daughter, who was depressed and questioning her gender identity.

“I just remember the anxiety of being in that space of feeling like someone had to help us.” But who? Where are they?” said Vera.

Over the past few months, we’ve reported on the obstacles residents face in getting help, despite laws in place to ensure coverage. Here’s what you need to know about mental health parity laws.

What is mental health parity?

Federal and state parity laws require insurance companies to cover behavioral health services like therapy the same way they cover physical health services like doctor’s appointments. Parity laws prohibit insurance carriers from being more restrictive based on measures such as copays and number of terms covered.

With some exceptions, mental health services are a covered benefit for most Coloradans with insurance. However, residents regularly have problems getting care.

It can be really, honestly, like climbing Everest twice without oxygen to get through from the time you realize you need help, and then within seven calendar days to get in or sign up for your first therapy using your insurance , said Cara Cheevers, director of behavioral health at the Colorado Department of Insurance, about getting care within a week, according to regulations.

If there are parity laws, why is it so hard to get help?

Several reasons. One is the widespread problem with inaccurate vendor directories known as “ghost networks.” This is when an insured person pulls up a list of therapists online, but is then unable to connect with them by phone or email.

You might find out that person is no longer online, Cheevers said. They may not even be in your country. They may not even be real. You might have the same person duplicated five or ten times, and they’re not taking new patients.

Colorado regulation requires insurance companies to regularly update their directories. The state Department of Insurance is currently working to determine the extent of the ghost networks here.

In addition, in many rural communities, Colorado has a real shortage of therapists, counselors, psychologists and other health care professionals. But perhaps an even bigger problem is the lack of insuring providers. In some cases, insurance reimbursement rates are too low. For many, the process of joining the network, called accreditation, takes too long, sometimes up to four months.

It’s too hard to figure out how to connect to the network. There are challenges with the administrative burden of taking out commercial insurance. Some providers will say it’s not worth the extra upfront for that, Cheevers said.

For now, residents who can afford to pay out of pocket are doing so, while others are trying to find a way to get in-network care or go without assistance altogether.

Over the summer, the Insurance Department asked companies to speed up and streamline the process. Efforts are also being made to include more pre-licensed and insurance-covered providers to alleviate workforce shortages.

How does Colorado enforce its parity laws?

In 2019, lawmakers passed legislation that expanded parity and gave the Insurance Department more authority. That’s when the Cara Cheevers business was created. Her department now has three employees.

The Insurance Department proactively pursues parity through actions such as annual reviews of pharmacy copayments and benefits. They issue regulations and fines. But enforcement without enough consumer complaints can be difficult; last year, the department received only 48 behavioral health complaints.

It takes a lot of work and it takes a lot of time and a lot of times changing policy isn’t sexy either, right? For example, we changed this regulation and now we collect data on reimbursement rates and someone who is in crisis or someone who is struggling to get out of bed, that doesn’t work, Chivers said. That, I think, is inherently just pushing the system and changing the system.

Are Coloradans aware that due to the parity law, mental health services should be covered?

Struggling to find care is a common experience, but many people are unaware of their consumer rights. According to the most recent Colorado Health Affordability Survey, 70% of people who missed out on needed care said they didn’t think their insurance would cover it.

If you are unable to receive covered treatment within the specified time frame, your insurance company should approve the treatment to an out-of-network provider in writing.

Some help is out there. For insurance questions and to file a complaint, the Insurance Department has a consumer services team available by phone or email.

Colorado also has an independent behavioral health ombudsman that residents can turn to for help navigating the system.

KUNC is part of the Mental Health Parity Collaborative, a group of newsrooms covering stories about mental health access and disparities in the US. Partners in this project are the Carter Center, the Center for Public Integrity and newsrooms in selected states across the country.