Some mental health care providers said a number of insurance company practices are driving them out of the insurance network, including the little-known practice known as "clawbacks."

A clawback is when an insurance company tells a mental health specialist the care they provided was not actually covered by the patient's insurance, sometimes months or years after the fact, and the insurer wants the money back.

Deborah Steinberg, senior health policy attorney at the Legal Action Center, said it is a tough situation for mental health providers, who are already compensated far less than other medical professionals.

"If you can't rely on that money you've been paid -- that you know was provided related to services that you were supposed to be providing -- it's scary for folks, especially if you're a small or solo practice and you're operating on really thin margins," Steinberg pointed out. "It's an additional burden and a level of anxiety that most people aren't comfortable with."

Steinberg added even if a patient finds a provider in-network, they often run into insurance providers denying claims for behavioral health care. A report by RTI International found insurance companies pay physician assistants 19% more than psychiatrists and 23% more than psychologists.

In 2021, patients had to go out of network three-and-a-half times more often to see a behavioral health clinician than other types of providers.

Jake Swanton, vice president of state affairs for the mental health advocacy group Inseparable, said clawbacks are just part of large administrative costs hindering mental health professionals from providing care. The hurdles, he noted, have led to more providers not taking insurance in order to operate.

"There's just so much pressure on the existing behavioral health providers on cost, and that they're being paid little -- and then squeezed even further by administrative burdens, clawbacks of payments that are being made -- it's forcing a lot of these providers who are just small business owners out of network," Swanton observed. "Forcing them to not take insurance so that they can run their business."

The RTI study also found nearly 7% of Marylanders' visits to behavioral health specialists are out of network, compared to only 0.3% of medical or surgical visits.

Indiana families are preparing kids for back-to-school season, and mental-health experts say emotional readiness is just as important as school supplies.

Beth Trammell, a psychologist and professor at Indiana University East, said kids often carry anxiety into the new school year. She encouraged parents to help children identify those fears.

"We as parents or caregivers think, 'Don't worry, or don't stress.' Instead, we might want to say, 'OK, well, let's talk about what it is you're worried about. What is the worst thing you think could happen?' If we draw it out of them," she said, "it may give them space to kind of let that out."

Helping kids feel heard can reduce stress. But experts also urge balance, keeping mornings calm, easing into routines, and not overloading schedules the first few weeks.

Nicole Brady, chief medical officer at UnitedHealthcare, said mental-health support should remain a priority throughout the year.

"Though we want our kids to be involved in activities and be social," she said, "we have to watch their academic performance, their mood, those sleep patterns, and making sure that those are staying healthy."

Brady added that parents should talk regularly with kids, model healthy coping and seek help early if warning signs appear.


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After a legislative session which opened doors to expand mental health care services across Montana, a state commission said it is considering the Billings area to build the state's second forensic facility.

For people involved in Montana's justice system whom a judge has deemed not mentally fit for their own defense, there are 53 beds in the state's only forensic facility in Galen. The daily waitlist hovers at about 100 people.

Matt Kuntz, executive director of the National Alliance on Mental Illness-Montana, said it is not meeting the immense need.

"It's just a really bad situation for the people that are in the jails, for the people that are caring for them, for the taxpayers," Kuntz outlined. "It just doesn't work for anybody."

At a recent commission meeting, Montana Department of Public Health and Human Services Director Charlie Brereton said the state is identifying a location for a new facility. The department received nearly $27 million from the state in April to fund project planning.

Kuntz noted the Montana Legislature passed many bills this session centered on mental health care.

"We really were able to get big wins in access to outpatient care, access to crisis care and for people in need of forensic hospital," Kuntz explained. "Overall, it was really an amazing legislative session for Montanans with mental health conditions."

Other mental health legislation will boost school-based services, youth in residential care, the state's 988 crisis line and certified community behavioral health clinics.


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The California Parent and Youth Helpline is in serious jeopardy after Gov. Gavin Newsom cut it from the new state budget, saying the money was needed to support medical services.

Advocates said they are puzzled because the governor has championed the helpline for years, and lawmakers approved $3 million from a separate fund dedicated to mental health, which does not affect the deficit.

Lisa Pion-Berlin, president and CEO of the nonprofit Parents Anonymous, which runs the helpline, said it is still operating 24/7, for now.

"We're holding on for the next month or so," Pion-Berlin pointed out. "But we need the state to step up, or one of these well-off philanthropists who cares about having that immediate help for emotional support, which is so vital."

Advocates are hoping funding can be restored via a budget trailer bill in the next few weeks. People can call or text and reach the helpline's trained counselors at 877-427-2736. The free helpline has connected with more than 120,000 people since its inception five years ago, and the website CAParentYouthHelpline.org has reached a million more.

Pion-Berlin noted a study in the Journal of Technology in Human Services found a call to the helpline can quickly ease parents' suffering and feelings of isolation.

"The research said that 85% of the callers in less than 30 minutes feel more positive, more hopeful and able to address their issues," Pion-Berlin reported. "There is no other service or pill I know that can do that in 30 minutes or less."

Parents Anonymous also offers free weekly support groups to steer parents and kids through emotional crises of all kinds.