¶ Maternal Mental Health Insurance Challenges
hey guys , welcome back to preview alliance podcast . This is sarah and I got my girl whitney .
We are back and we're gonna be controversial today y'all , we hadn't had a chance to do the podcast in a hot minute , and so we are locked and loaded today we are fired up and something .
So , if you guys are new to the podcast , we've got a lot of new listeners lately and we're super excited about that . But I had postpartum depression . I'm a nurse by training with my oldest , and Whitney is a maternal mental health therapist . She has had her own experience with postpartum anxiety and she sees our Previa moms .
This is her niche and so what we have been doing recently with Previa Alliance our Previa Alliance moms know that is a maternal mental health company that is based in the South and predominantly in Alabama . Right now we're working to access other states , but we are fighting for maternal mental health to be recognized as a benefit .
It should be a benefit preventative care , to have access of care , all the things . So we're going to give you a little insight of just the landscape of maternal mental health . Why , if it feels like it's hard to get mental health care , it is .
And some of the experiences we have had and things have been told to us by people in government , in payers , in doctor's offices , friends , family , when we're trying to fight for you . So , whitney , let me tell you this . So I learned this recently and I cannot stop sharing this .
But so everybody kind of thinks , you know well , mental health should be covered , right , or I would assume that if I did experience depression or anxiety , that I could go to my physician , I could get help and they can navigate it , and that is simply not true .
I was about to say . I hate to say this , but it's a little hit or miss . It depends on your doctor , it depends on your doctor , it depends on your doctor , it depends on your insurance ?
Yes , and it literally . For example , you know , I was talking to this one mom recently and she said you know , I told my doctor that I was not feeling like myself , I didn't want to be around the baby . I was just questioning why I was a mom and I was told postpartum depression is not real . And I was like , okay , well , that's false and I'm so sorry .
I said , well , what did they say ? And they said , you know , probably just the baby blues . You'll get over it . She was four months postpartum Stop . And if you even think about the moms who are brave enough to say anything about how they feel , they're speaking up .
It's incredibly uncomfortable to talk about your thoughts and your feelings when society is telling you this is the most perfect time of your life , you're so blessed to be a mom , you should be so happy , right . And then you're met with someone saying what you're feeling is not real , or they classify as the wrong . Yeah , they classify as the wrong thing .
That is not baby blues . For our listeners baby blues go away on their own . They should definitely be gone by four months . We generally say they're gone in a couple of weeks .
Two to three weeks is your guideline .
And so for her to be four months postpartum and saying to us calling us , that is signs of postpartum depression that she's experiencing , for her to be shut down , and she said I walked out and I didn't know what to go from there Because she's like that was my provider . What do I do ? Do I find a new provider ? She ?
Said my insurance needs a referral for me to see a therapist , which there is a lot of insurance that require a provider referral .
That's not uncommon for insurance to require a referral for a specialist . However , being a therapist myself , a lot of times people do cash rates . Depending on your insurance deductible , you may be better off doing a cash rate versus paying your deductible before insurance even kicks in .
And that is so true because we have several situations where we have helped premium moms that , honestly , their deductible was so high and they had no idea that they had to pay towards that deductible such a high amount before they could get therapy .
A lot of people assume therapy or psychiatric services are fully covered , and they're not for a lot of people , so that's a huge thing , Sometimes , even if you have the same company , same policy with insurance , they can change things year to year .
I have a client that I had been seeing for , I'm going to say , about two years give or take Cancer survivor , mind you . Okay , Went through quite a bit of things . Rolls over from 23 to 24 , come to find out Blue Cross changed what they were covering and eliminated any type of what they called behavioral health be covered under their insurance .
They could no longer see a psychiatrist . A cancer survivor no longer had access to mental health care because insurance changed what they wanted to cover .
I believe it . I believe it and even if , in this area , what we're seeing in the therapy world and our pre-valence therapists don't fall in this , you know , for a reason , who we choose to partner with . There is reasons we partner with certain groups and therapists .
But we're seeing where to say , you did find a therapist and you're like , cool , they take my insurance , my deductible . It's not . You know , I just have this copay , which copays can be a lot of money for therapy Very quickly .
And there is this part that you know I've I've had therapy in different insurance coverage and when you are paying for it , there is something in the back of your mind that , like you were just like , do I really need this ? Even though you know you need it , you question like , am I taking money away from like my kids ?
Or like , is that shame , guilt , weirdness , that happens right .
We speculate if we should spend that on ourselves because it doesn't feel like a necessity sometimes and the economy is not great right now and people are struggling to put food on the table .
So I can see where someone would feel guilty and view therapy as a luxury , as something like I don't have to have that to survive , I need to put that on the back burner , and I get that . I mean , you have to make ends meet , you have to feed your babies . I thousand percent get that . You have .
You have to make ends meet , you have to feed your babies . I thousand percent get that . You have to pay the power bill . But therapy can also be a way to help you survive .
A hundred percent and it is what we're saying in this conversation is , you know , they're not making it easy for you to get your mental health taken care of and it's almost set up for you not to , and even , to the extent of you know , so , therapists who get your claims paid by an insurance company .
So therapists have to bill , write your notes and everything has to be tidied up with the claim charges . Well , it's very difficult and it's at times payers look for anything not to pay . So to the point , and it's hard for a therapist to get credentialed . It's hard for any provider really to be credentialed into insurance .
I mean , there is companies out there that their whole job is to get you credentialed with the insurance . Right , it is a process . It's a process . So for you to utilize a benefit , you're probably going to pay for it . Your therapist is it's work to get that payment from the payer and then .
So then you have a lot of therapists going I don't want to take insurance anymore , for whatever reasons , the hassle , and so they're going to cash pay . Well , not everybody can do straight cash pay Right . Cash rates can get expensive . They can , and I'm not saying people shouldn't . Like you know , their time should be valued and paid for their worth .
But it does set the system up where those who can pay , and always have been able to pay , will continue to get service and those of us beneath and in the middle do not get that . So it's not as simple as I'm having . I'm struggling with my mental health , I'm going to use my insurance , find a therapist , and all this happened in a short amount of time .
Wait list can be six to nine months for a therapist or a psychiatrist , and the caveat we've learned with some of our previous moms is inside the insurance policies they may dictate that it's in person and not allow for virtual .
Which boggles my brain . Because did we not learn anything from COVID ? That virtual is something that we are capable of doing and still really getting about 95% of the same benefit , if not 100% ? Really getting about 95% of the same benefit , if not 100% ?
Well , the fact that if you think you're a mom , you're busy , you have a newborn , whatever , you have multiple kids , you're working , you could do therapy during your lunch break , if it's virtual right , you could go to your car , go sit on a bench , hop out your phone , click your Zoom link .
The effort it takes to physically go to a therapist's office , the money , the time , the childcare I mean it's a commitment , it's more than just your therapy session . So we're fighting actively for payers to allow for virtual therapy . And there's these codes for called postpartum depression prevention Intervention Codes . They were mandated from the Affordable Care Act .
Now I challenge everybody who's listening to this to go to your insurance benefits and look to see if that is offered by your insurance company . Now there's a caveat with everything when it comes to insurance , it has to be done in person in certain states . So something that is free to you , you don't have to pay a copay .
It is mandated to be covered federally . Now they're putting restrictions on you , saying you got to go in person , which that generally falls on the OB , and we love our OB partners , we love them , but it's not their wheelhouse to truly give maternal mental health . So what happens ?
You have a preventative free benefit you cannot access because the system is not set up for you to get that . So you literally have a benefit right there , but it's like dangling the carrot you can't get it Right .
Which is angering , because why are we trying to circumvent this ? Yeah , why are we trying to limit people and I mean I'm going to get my little like get more of a benefit or profit to be reactionary to an issue versus preventative , because there's a lot of data out there that actually talks about how people can benefit more from therapy versus a medication
¶ Challenges in Maternal Mental Health Care
. That being said , I'm all for medication . If you need a medication and it works for you , you take that medicine . You take that medicine . However , who benefits from that ? Yeah , insurance companies get some type of a kickback , pharmaceutical companies get a kickback from it . So that's why it's like no , no , we're not going to let you have this therapy .
We're not going to let you do it virtually . We're going to do all of this stuff . Oh , you need a medicine ? Sure , we can get you a medicine after you have been struggling for six to nine months screaming for help .
And no one will help you . And on the fact of medication . So I learned this recently . So you know , I thought , and again , we love our psychiatry friends , but I assumed if I needed mental health medication my mind as a nurse goes okay , a psychiatrist would probably be the most appropriate person for this .
Now , when you talk about maternal mental health , so we're talking about mom's mental health from , say , you know , infertility to postpartum , you know , infertility to postpartum and postpartum is not just six weeks , like we're talking like one or two years , Some people say even four years after childbirth .
You assume a psychiatrist would have exposure and education on how to prescribe the proper medications . Well , so ACGME , which is the accrediting institution for like , physicians , right , and they do the boards and certifications , all that jazz , and they kind of dictate to the residencies and fellowships what they have to teach , right .
So maternal mental health is not a requirement to be taught or have on staff . So we're talking there is and I've been told this by psychiatrists . They have went through residencies , they've went through fellowship and they have had minimum exposure and education on how to treat a mom who is suffering with her mental health .
What's safe to prescribe for breastfeeding , what's safe for the baby ? What would you know the proper medications ? Do you start or stop her on a medicine as she comes into pregnancy ? It's simply not taught . So , if you think about it , an OB may go well , that's not my wheelhouse . A primary care physician may go like that's not my wheelhouse .
They go go see psychiatry . Psychiatry is like , ooh , I really didn't get a lot of training on this . And then what does the mom do ? She's left and she's going . So who knows what's right ? Who can help me ? So , to the point , this is such an issue . One of our advisors from MUSC , dr Smith .
She has been great in helping me navigate this because to reach the level of moms we want to reach , we need to partner with providers who know what to prescribe , not to stop a med , you know all these things .
And so there was a task force made and there was a curriculum called the National Reproductive Psychiatry Curriculum that reproductive psychiatrists have created . They came together and they said listen , we're in a crisis . Psychiatrists , obs , pediatricians , primary care nurse practitioners , pas they are not getting exposure and proper training .
We're going to make a training and let them access that . So one thing that we are doing on a greater scale is trying to get residency programs , medical school programs for these physicians to take this curriculum and learn about it . Because what good is it doing for anybody if you're going to these providers and they don't know how to treat ?
you Right , and they feel like , oh , that's not mine , let me , you know , punt it to someone else . And there the mom is suffering the whole time , doing what she is told to do and getting nowhere .
Nowhere . So I assumed I was like well , this is the most common complication of pregnancy , aren't they being taught about this ? Are physicians being educated ? They're not , and so if you feel like you met a provider along the way , you've been dismissed , gave false information , maybe they stopped a med when they shouldn't have , kind of situation .
There's a little backstory to they probably have very limited exposure .
Right . And it's not a requirement and you don't want to own up to I haven't been given exposure to this versus saying , oh , that's not my specialty . Exactly .
I mean I don't blame them right , Like you can't control , like a nurse in school . You were in , you know , when you were in grad school . We could not dictate what was taught to us in our curriculum . Right . It is a failure at a higher level that we're failing providers and moms and our babies , that we're not making this a requirement for education .
So , if you think about it , they're not being mandated to know about this . Reproductive psychiatrists who are dedicated psychiatrists to moms trying to get pregnant all the way postpartum they're rare . We don't have one in the state of Alabama . There's many states that do not have one . So if you're like , oh my gosh .
And then , if you think about this , so insurance companies , and there's no federal regulation that says that a mom has to be screened for her mental health during pregnancy and postpartum . There is nothing that mandates that .
It's recommended by several organizations , but there is nothing holding people to the fire saying you have to be screened , like , say , there's mandates about , you know , heart screenings and diabetes and colonoscopies Right , but mental health for moms , there's nothing making your OB provider , your pediatrician , your primary care doctor , your hospital , your hospital , screen
you for the most common complication , and then , on top of that , they're very poor reimbursement .
So , unfortunately , this system it is what it is more times than not is so they don't traditionally bill every single month for , like , say , you went in for an x-ray , your doctor bills and you know pays for that Right and then you go in the next month that you see them . They bill for that . So that's right . Single visit charges .
How OB is paid is a maternity global code .
Yeah .
So you get . They send one code when you deliver and get one bulk payment and in that , right now , in a majority , there's nothing for your mental health . There is nothing that's required them to do anything about your mental health and get paid for it . So I have been told it's don't ask , don't tell Sarah I'm not getting paid for it .
So I have been told it's don't ask , don't tell Sarah I'm not getting paid for this . I discharged the mom at six weeks and I'm done with her . I don't want to follow her through postpartum . It's too complicated . It's too complicated . So you're literally dropping a mom in her most vulnerable time and there's nothing making them or paying them .
Legally there's nothing wrong Ethically I would argue but legally , liability wise , there's nothing that can be done against the doctor for doing that . There's nothing that can be done against the doctor for doing that and honestly , they may view it as a higher liability to continue care post six weeks .
You know . So Medicaid moms , let's talk about a Medicaid moms . I learned this . I learned this very . We have been searching and seeking and advocating how to reach Medicaid moms . So the current codes that PREVIA uses to provide education , screening , navigation , support , where you have a personal navigator assigned to you .
They're a counselor or social worker who gets to know you , and then you have your therapist and then your OB has access to our psychiatric team for medication , consults , education .
Now the codes we use for that do not exist in Medicaid currently and I've went to Medicaid and I've asked , and on top of that , the reimbursement for Medicaid so what Medicaid will pay for therapy is drastically lower than what , say , blue Cross , blue Shield will pay , and so there's issues and difficulties getting to be credentialed with Medicaid .
So we struggle to find therapists to see Medicaid moms . We struggle to find OBs to care for Medicaid moms and certainly we struggle for OBs to have a Medicaid mom past six weeks postpartum if they do take her .
And then to the point I've seen on OB websites that say I will only accept a Medicaid mom from pregnancy to six weeks postpartum , I will not follow during postpartum , and so these moms are 50% of births in our state . They're the ones with all the risk factors .
They're the ones that are struggling , that need us , and so what we have been doing at Previa is we have been beating down the doors of legislation , of government , of nonprofits anybody that will listen to say how do we reach these moms ?
Right , I have so many thoughts and not a lot of them are positive . I'm just going to be honest because in you know my history and for listeners , for nine years of my career , my job was to coordinate prenatal care for Medicaid moms and I loved it . I loved doing that . So Medicaid mamas really hold a very special place in my heart .
More often than not , these moms are already struggling . There are financial disadvantages , there are housing , there are social support disadvantages going on . So it is a more vulnerable population for the most part , and to shortchange them on their care from an OB perspective makes them more vulnerable and higher risk for so many other complications .
Higher risk for so many other complications . Because what I would want to ask ? That OB is okay . What if that mom is six weeks in one day postpartum and all of a sudden she starts having complications with excessive bleeding or her C-section incision ? Are you going to say nope , it's six weeks in one day , can't see her now ? No chances are .
You're going to go in and evaluate what's wrong . What's happening right now ? What causes ? Is there retained placenta ? Do we need to do an emergency DNC ?
Yeah .
So why on earth do we think we can stop any type of mental health care at six weeks in one day , when chances are you wouldn't actually stop any type of OB care at six weeks in one day ?
No . And two , we are big fans of collaborative care codes . They're not active in our state , they're not active in several states , but to that point , for Medicaid moms that is certainly not active , but if it is in some states , if we're even talking about disadvantages of moms , is there's cost share ? Would those cost share payments ? 50 , $40 a month ?
Yeah , so even if you were to establish something with your you know , say , if Preview was like okay , here , you know , we can support , and that would encourage them to continue the care past , you know , six weeks postpartum , if they knew they kind of were in it with somebody else to manage their mental health .
Because I think the core of it is is there just like well , I don't really am comfortable , I don't know what to . You know how to treat her . I can't find a therapist for her . I can't find a psychiatrist , what do I do ? I'm not getting paid for any of this . I mean , that's just kind of like what the providers think .
So say , if you had a collaborative care approach where we work with them , you're still asking a mom to pay a lot of money for her mental health monthly and that can't happen . Well , they don't have it . No , no , they're saying , they're like , oh , it's just 40 bucks .
I'm sorry , but $40 can be a can of formula for somebody , that can be groceries , and again we're already looking at a population that maybe doesn't have a whole lot of disposable income . They may not have $40 a month or they have to sacrifice something else to make that happen .
And that's where there is actually a bill that was just released . I don't think it's going to get passed . It was from I believe it's a New Hampshire senator and I forget the other one , but they were trying to mandate that maternal mental health , from pregnancy to postpartum , had no cost sharing on the ball . Now I do not believe it'll be passed .
I'm very hopeful , but that's the kind of things that need to happen . And so if you're hearing this and you're like , what can I do ? Well , what you can do is you can learn about maternal mental health . You can go back into our podcast . We have so many great what is ? Series that we did .
Learn about risk factors , learn about the signs and depression , anxiety , ptsd , ocd , psychosis . Educate yourself , be aware of the statistics and go to your provider and say I want this , they can . Then you can write your legislator , you can call your insurance company .
I mean , let me tell you , my insurance company knows me very well and because I'm saying well , why can I not access this benefit ? Why are you putting this restriction ?
And until we all join in the conversation , because no one's not gonna , you know , I I tell people all the I'm like I don't see how moms don't have maternal mental health issues because the system is set up for us to fail .
Correct , they do not care . Again , we like to be very reactive and not proactive .
I mean , it takes a headline , a death , for them to say it's a crisis . Well , it's been a crisis and it's going to be a crisis if you do not start ground zero .
Honestly , though , how many headlines have we seen without any traction ?
Well , because now it's like something happens to a mom , right , and it's like you're numb to it , right , like you're . Just like the media is like they'll make one little sentence about postpartum depression or psychosis , or they move on .
Well , I can remember , and this has been several several years ago there was a mom who put like a cinder block or a brick or something on the gas pedal .
Her kids were in the car and they were varying ages , I want to say like infancy , to like early elementary school ages two or three children in the car and drove it into a lake and they drowned and everyone was calling her a monster and how horrible , and don't go wrong . That is terrible and that is tragic and it it is heartbreaking .
But having the knowledge I have now , part of me is thinking did she have postpartum psychosis ? Did she have postpartum depression ? What else was actually taking place ? Because she was made out to be a monster ? When I'm going to give her the benefit of the doubt , she didn't do it just for funsies .
No , that's something that drove that behavior . I mean , that is not a natural response as a mom to do that or a human .
¶ Moms Advocating for Mental Health
And we know about psychoses and psychoses for listeners who've never heard that term before . It's a medical emergency .
Absolutely it is . That is ER level . It's a medical emergency . Absolutely , it is that is ER level .
It is not spoken about , it's not educated about . And so postpartum psychoses actually , during postpartum a woman is I believe I forget the statistics 20 or 25% more likely to have psychoses during postpartum or pregnancy than she is in any time of her life .
And psychosis is when you are delusional , having hallucinations , you are not auditory like you believe it , and it's like you're not in your own reality and you need someone else to help you . You cannot ask for help right and no one's talking about it right until after that .
So yes this has been probably more of our sassier , heavy , heavy-handed but , but we are out here fighting for moms and we won't stop fighting .
And some of the more ridiculous things that's ever been told to me is we've went to try to get partnerships in different OB offices and I've been told well , the office manager thinks it's too much work to build so that you can have this service for free . I've been told bill so that you can have this service for free . I've been told .
You know , we're really opening up a Pandora's box . If we start educating and screening , we're going to find more depressed moms .
They're still there , whether you screen them or not , and if we screen them , we can equip them .
I've been told there's no need to escalate . There's no need to move this up higher . It will get reviewed when it gets reviewed from a payer . I've been told women don't pay enough for healthcare in general .
They can pay co-pays . I'm sorry what ?
The amount of things that I am told on a weekly basis . That sums it up that moms are just not worth it to a lot of people . You know , when you say there's no mandate in maternity leave and they're like , why would she need more than six weeks ?
All these comments that when I share with people , they're like someone actually said that to you and I'm like , yes , people have said that to me who have a position to be able to change things .
Yes .
So all this to say is your voices matter and the more we join together and say enough and you rattle some cages .
Right .
Call , write , post , share . Yeah , say enough , and you rattle some cages . Right , call , right post share . Yeah , you know , that is what we're asking and to know , like this is not , this is not . One in three moms will experience a perinatal mood anxiety disorder .
Post-covid the number shot up , it used to be more traditionally one of five , one in three , and it can range right mild , right Mild to severe , all that . But it's happening , rather if they want to recognize it or not .
Exactly , and it's a discerning that's not just to the mom but to the baby and to the part in the family Like everybody .
Yeah , employers are wondering why new moms are not coming back to their job . Hello , we can't do it all .
We can't do it all .
We can't do it all and the mental health is health and it should not be something that we are fighting for . It should be part of our care and it should be expected . So just know , if this resonates and fires you guys up , like it fires me and Whitney up Right , do something about it .
Share this Talk , demand more for yourself Right and for the women around you Right and , like you mentioned , going back to these previous episodes that have education on what the signs and symptoms are of all the varying postpartum and mental health diagnoses , you can advocate for yourself with your provider , and that's unfortunate that we do have to be our own
advocate , but I think we're in a spot where we don't have a choice to be our own advocate .
So education is . We always make this podcast accessible and free and that is because we believe every woman , not depending upon her race or education , her zip code , her situation , should be provided education about her mental health for her to be able to have a like . If you know about it and you are aware that's half the battle and equip yourself .
Go back to some of the Toolbox Tips episodes , go back to some of our guests even we've brought on and they'll give you , they tell you kind of ways they got through it , how they mentioned and so and if you're like I'm being met with this resistance or someone said this awful thing to me about it , you're not alone in that and I wish that didn't happen to
you . But no , that's not an isolated event and that just you gotta keep moving Right , absolutely . Challenge for everyone who's hearing this listen , learn , advocate and share for us and we'll keep doing the same for you . That's right . All right , guys , till next time we will be back . All right , see ya .
Maternal mental health is as important as physical health . The Preview Alliance podcast was created for and by moms dealing with postpartum depression and all its variables , like anxiety , anger and even apathy . Hosted by CEO founder Sarah Parkhurst and licensed clinical social worker Whitney Gay , each episode focused on specific issues relevant to pregnancy and postpartum .
Join us and hear how other moms have overcome mental health challenges , as well as access tips and suggestions on dealing with your own challenges as moms . You can also browse our podcast library and listen to previous episodes at any time . Please know you're not alone on this journey . We're here to help .