Is your insurance carrier among the worst when it comes to denying claims?

Is your insurance carrier among the worst when it comes to denying claims?

I don’t have any better way of naming this phenomenon besides “shameful” and “disgusting”.  

Two takeaways:  1. If you have a choice, choose an insurance carrier that actually pays its claims, and 2., if you get a denial, appeal it!

The last thing someone needs when they are navigating challenging life transitions, struggling with catatonic depression or paralyzing anxiety, grieving, or fighting for their relationship is a bureaucratic hassle for reimbursement that they have bought insurance to cover.  Insurance companies count on their insured members’ not bothering to appeal denials.  According to Barbara Griswold’s study (which references the Kaiser Family Foundation’s study of claims and Healthcare.gov) only 1% of denied claims are appealed, but when they are appealed, somewhere between 40-75% of the denials are reversed.

Following are some of the worst offenders, according to Barbara’s research:

• Oscar Health (25%)

• Molina Healthcare (22%)

• Guidewell, parent company to Florida Blue (22%)

• CIGNA (21%) 

• Blue Cross Blue Shield of Tennessee (21%)  

• United HealthCare (19%)

• Health Care Service Corporation (18%)

• CareSource (18%)

• Centene (18%)

I’ll add anecdotally that it’s very hard to get mental health care through Kaiser Permanente of California.  Over the decades I’ve been practicing, I’ve seen many patients struggle with access to mental health services.  According to Calmatters, Kaiser “faces significant scrutiny over mental health care, including long appointment wait times, chronic understaffing, and reliance on group therapy over individual care. The provider recently reached a $200 million settlement in California over state violations regarding access to mental health treatment, with further fines related to federal regulations occurring in 2026.”  

I made the tough decision to resign from insurance panels a couple years ago due to the administrative overhead, hours spent on hold with insurance companies, and unsustainable low reimbursement rates -- and occasionally being unpaid for my work.  My going out of network

means that I collect session fees at the time of service, and I provide what’s known as a “Superbill” which clients can submit to their insurance and request any reimbursement to which their coverage entitles them subject to their plan rates, deductibles, eligibility, and other limits.  If you are working with an out-of-network provider (like myself), make sure to check your coverage with your insurance provider so that you won’t have any surprises.

To do my part to keep mental health services accessible, I attempt to keep a few slots open for clients who are referred by certain employer-funded Employee Assistance  Programs (EAPs), which usually provide for a limited number of sessions with no fee and very little administrative hassle for either the client or the therapist.  In some cases, clients are satisfied with the progress they make in those few sessions, and in others, the covered no-charge-to-client services at least give a start.