Dave Meichsner spent 25 years in the tech industry before going back to school to become a clinical social worker.
“My wife was a social worker, and she would tell me about the things that she was doing and helping people,” he said. “And frankly, I was jealous.”
He and his wife now run Women’s Counseling of Nashua, a practice with about 20 clinicians. But these days, Meichsner spends only half his week seeing clients. The rest of his time goes to chasing down insurance payments.
He said it’s almost always due to mistakes made by insurance companies: denials made in error, incorrect payments, claims that simply disappear. He still has unpaid claims dating back to 2021. One company, he said, tried to take back $24,000 in payments it had already made – claiming, incorrectly, that a particular clinician hadn’t been in-network for the previous two-and-a-half years.
Trying to fix those issues can take months of frustrating calls and emails.
“I’ve had to, multiple times, explain to people what a deductible was,” Meichsner said. “And they work for the insurance company.”
'I think it's really contributing to the shortage that we have with clinicians in the state.'Scot Wilson, Enso Counseling Group in Concord
Meichsner is one of about a dozen therapists across New Hampshire who told NHPR that their frustrations with insurance companies are getting to a breaking point. They said late payments, erroneous denials and other administrative hassles are costing them time and money – making it harder to stay in business, and make time for clients. Some say they are so fed up that they’ve stopped taking insurance altogether.
“The breadth and consistency of the issues that we are hearing from behavioral health providers is very concerning,” said New Hampshire Insurance Commissioner D.J. Bettencourt.
Bettencourt said state insurance regulators are looking into these problems, and expect to take action by the middle of this year.
But in the meantime, local therapists say these issues are getting in the way of helping people who need mental health care – at a time when nearly half of mental health clinicians statewide have waitlists, according to a recent New Hampshire Psychological Association Survey.
“We don't go to school to do business,” said Scot Wilson, a licensed mental health counselor and co-owner of Enso Counseling Group in Concord. “We go to school to help people. So I think it's really contributing to the shortage that we have with clinicians in the state.”
Why some clinicians no longer take insurance
The New Hampshire Psychological Association also recently found about one in four therapists in the state don’t take any insurance. That includes some who work in schools and other settings that don’t require insurance. But the top two reasons were lost income due to administrative burdens and low rates of pay.
This is a concern across the country, said Dr. Marnie Shanbhag, with the American Psychological Association. Many therapists are leaving insurance networks because they can’t manage it financially, she said – which means fewer and fewer options for people who can’t afford to pay out of pocket.
“One of the things we had increasingly been hearing for some years is that it was getting more and more difficult to find somebody who accepted your insurance,” she said.
For New Hampshire-based psychologist Dr. Jeannine Pablo, the breaking point came last year.
She said she wasn’t receiving payments from an insurer for over a year – because they had her name misspelled in their system. Like most therapists interviewed for this story, Pablo declined to name the specific company, but said she was still owed around $54,000 as of last month.
That just wasn’t sustainable. But she wrestled with the decision to stop taking insurance, calling it a “forced choice.” She works with a lot of veterans, health care workers and first responders who’ve experienced trauma, and wants to be able to work with as many people as possible.
“It’s a hard conversation to have with somebody,” she said. “ ‘Hey, I can’t accept your insurance anymore because they don’t pay. So now you’re going to have to pay to see me.’ ”
Read more: For many NH families, finding a therapist for their kid is 'like a part-time job'
Therapists who still take insurance also say errors and delays are impacting clients’ access to care.
When Sarah Higgins, a mental health counselor in Londonderry, started her own practice last August, she’d been trying to contract with one of the major insurers for months. She’d send in signed paperwork, only to be told repeatedly her information wasn’t in the system.
It wasn’t fixed until she got the state insurance department involved, she said. By then, it had already interrupted care for about 20 clients who had worked with her previously and wanted to keep seeing her.
“They could not afford to pay for therapy without using their insurance,” she said. “So there was then a lapse in services for these folks, and I had no idea what to tell them in terms of when I would be officially in-network.”
Matt Fowler, a licensed marriage and family therapist who owns Olde Port Counseling in Portsmouth, said clinicians are sometimes mistakenly marked out-of-network, resulting in a large unpaid balance showing up on a client’s record.
That can lead people to stop or pause therapy, even when Fowler explains that the insurer should be responsible.
“It's leading to people saying, ‘You know, I can't be in therapy right now if this bill is going to be hanging over my head,’” he said.
State officials say they’re paying attention
Bettencourt, the state insurance commissioner, said it’s become clear these are not just one-off concerns, and systemic solutions are needed.
In fiscal year 2024, his office received 97 complaints from mental health providers who had trouble getting claims paid or ran into other difficulties with insurers, according to data released to NHPR under a public-records request.
'The breadth and consistency of the issues that we are hearing from behavioral health providers is very concerning.'NH Insurance Commissioner D.J. Bettencourt
Bettencourt said the medical billing system is complex, but he’s especially troubled by reports that it can take months of unanswered calls – and pressure from state regulators – for providers to get any response about why their claims are denied.
He said the department is currently looking into the insurance industry’s practices. He said he couldn’t go into detail while that inquiry is pending, but he expects it will lead to companies being required to take corrective action.
“The carriers are going to have some things that they’re going to have to address and fix,” he said.
AHIP, an industry group, declined to make anyone available for an interview. In a statement, a spokesperson said its members have worked to add more in-network mental health providers. They also said they comply with requirements to maintain adequate networks and cover mental health on par with physical health care.
“Prior to and since the pandemic, health plans have been responding to the growing need for patients to access mental health services by increasing their behavioral health networks, providing access to care via telehealth and also supporting primary care providers who have taken on a greater role in triaging mental and behavioral health issues,” a spokesperson for the group said in a statement.
Dave Meichsner, the social worker in Nashua, wants to see more accountability. New Hampshire has laws governing insurers, including a requirement that claims be paid promptly, but he doesn’t feel there are enough consequences for violating them. He and other local therapists have formed a group called Clinicians United, to bring attention to these problems and advocate for fair treatment.
“The issue is that there’s a power imbalance, right?” he said. “So they are clearly in violation of their contracts. But as a small company, what are we going to do?”
