Quick summary

 Dr. Langeland is a licensed professional counselor and owns her own business called Mind Body and Counseling Services in Kalamazoo County. Dr.  Langeland allowed myself and another student to interview her in her office. Dr. Langeland was happy with the addition of mental health coverage in the new healthcare plan. She thinks that with health insurance covering mental health it will improve access and opportunity for people to seek mental health assistance. She believes that mental health care should be seen as preventive care, especially for chronic health conditions because as Dr. Langeland explains, “stress can be physically damaging to your body and being able to talk or deal with stress can be a form of prevention that can eliminate other risks”. She also mentioned that her client demographic might change with time for instances seeing more young adults, people who have jobs, or people who have partners with jobs will be more present in seeking mental care assistance; yet she also believed that the demographics, generally, would also change if there were not such a negative stigma involved with going to see a psychologist or a counselor.

Dr. Langeland also explained the complication of the reimbursement processes and some of the kinks that need to be worked out before it can be completely beneficial for both the providers and the clients. The main issue with the reimbursement process is the efficiency in terms of timing, the amount of reimbursement, and those who are being reimbursed, as well as the cost of filing for reimbursement. The complication that comes with the insurance companies can make clients with public insurances undesirable to some providers. The complications of reimbursement means some clients will not be able to find providers that have the desire to work with them, which has implication on how comfortable and likely clients will be to return to receive care.

Dr. Langeland brought up a lot of amazing points about what is occurring with mental health benefits based on the new insurance and she gave a lot to think about from another great professional perspective that is less heard of.                                                           

Work environment

 I had the privilege of interviewing Dr. Langeland in her office at Kalamazoo College. Her office was nice and spacious and had a large table in the middle with some papers nicely piled as to where we conducted the interview. She had lots of books and experimental tools in the cabinets and walls. Dr. Langeland was very comfortable in her work environment and it showed through the space.

Quotes

• “I believe that when people can manage their stress well and deal with the stressful things that are going on in their lives, then that is some of the best prevention there is. In doing that, it is changing how their bodies are reacting to stress, which is establishing a better base line in health, in general, and not creating the conditions that give rise to chronic health conditions.”
• “I had a client come, that supposedly, still had insurance but did not have mental health benefits, and I was operating under the perspective that that was no longer legal. That mental health parity was reimbursable, they have to reimburse mental and physical at the same rate. She went back to her insurance company and they said if they were not choosing the mental health services from the beginning, they didn’t have to cover it. I’m not sure what is going on there. There is some loopholes allowing some people who have established health care to not have mental health, and it seems sketchy to me.”
• “But I think that national policy can have a dramatic impact on that, if everyone who’s on the news talked about “go to a therapist and deal with your stress so that you don’t get heart disease.” If that was the cool, latest thing, and then we had access to health care, I’d have a full practice. But that is not millennium we live in.”

 

Question and answer

Q: Where do you work and what you do?

A:  I am in private practice; I am a licensed professional counselor. I own a business called Mind Body and Counseling Services.  I see clients at my practice four days a week that range from 13 years old to as old as they need to be; I see adolescents and young adults.

 

Q: How many clients do you currently have?

A: Right now my practice is small. I am in the process of growing that practice, so I see 10 to 15 clients.

 

Q: Do you think your clients are aware of the ACA and how it will affect them or not?

A: Right now, I feel like that the majority of the people I have seen have had established health insurance plans. There is some talk around the field that we will see a boost in the number of clients that are calling, but I have not really sensed that yet, given that most people are coming with established health care plans.

 

Q: Do you think it will have a great impact on your practice in the future?

A: I think it should, yeah, I think it should improve access to lots of folks. Interestingly, I’ve also done out of pocket pay when I got back into practice. I originally was, while I was working on getting on insurance panels.  I saw clients simply out of pocket. I did not take insurance, and you know, that was people who may have not had insurance anyways and they may have been used to paying out of pocket for their own mental health benefits. I also think it will impact those folks, because they would often come for 2 or 3 sessions and then not come back, then maybe a year would go by, and I would see them again. Nevertheless, they have all said that they were more interested in coming more often if they had insurance coverage.

 

Q: How do you think the new insurance will impact the idea of prevention care and people taking action with prevention?

A: I am a huge proponent, I believe that when people can manage their stress well and deal with the stressful things that are going on in their lives, then that is some of the best prevention there is. In doing that, changing how their bodies are reacting to stress, which is establishing a better base line in health, in general, and not creating the conditions that give rise to chronic health conditions. In that, simply coming to get help with whatever they are struggling with is a stress reducer. I think it will have an enormous impact on chronic health condition and can be considered preventive care.

 

Q: Do you feel like your demographic of clients will change especially with Healthy Michigan?s

A: Absolutely! I have seen a small uptake with those with Medicaid. I have been able to be reimbursed for Medicaid. Yes, absolutely, I do think there will be a shift in demographics. I am seeing people, who have jobs, or husbands, or partners who have jobs and or children, or people who are still allowed to be dependent. You know, that is another wonderful change. I have seen a growth in the young adults sector. I am billing 21, 22, 23 year olds’ parents health insurance, and that was not something that we could have done before.

 

Q: Do you think there will be more job opportunity for those seeking the realm of mental health?

A:  Just so you guys know, my license is in counseling, not psychology. Because my PHD is in counseling, and that matters in terms of reimbursements; I hope that will change because it hasn’t changed yet. There needs to be a shift in how reimbursement happens, that really is the biggest deal in terms of who they are choosing to reimburse and for how much. So right now, my business went into practice with another business so that I can be under an umbrella organization that already has established reimbursement. I had to do that so that I could get reimbursed because the health insurance company had put limits on the number of providers that they will reimburse in a certain area. That is particularly problematic, so not every new psychologist or counselor can go out and get on insurance panels. They decide whether there is any need for your services in the area and reject or accept you.

The time when I started applying there was a dramatic kind of closure that was happening. But about 15 years ago there was a dramatic kind of opening for lots of master levels and a variety of practitioners from social workers, to mental health counselors, to LPC, to psychologist, were able to get on insurance panels that were not able and then they closed that down. So, it is a really strange way that you have to go about getting reimbursed. So, people in my position pair up with someone who has reimbursement ability, and that person just signs off on all of their stuff and there are all kinds of little loop holes that people find to get reimbursed. But, in a fair system, that would be open to the practitioners that are here and you’d be able to choose the help.

For example, they are claiming that other people in this area do the same thing I do, but I know for a fact that no one does. There is a lack of understanding, so my job has to be part to educate. I’ve had to go to the health insurance companies individually, there is 50 plus that people can have in the state of Michigan and that would entail me going to all of them and educating them about what I do and why it is important and why its different. Then I’d have my clients write their insurance company letters, then me write another letter, and then after a year and a half of doing that kind of education, then I would get on a panel. It really is, in my opinion, a smoking and mirrors way for them to manage not having to pay out for services. When in reality, if they opened it up and gave more access, they would see a dramatic decrease in other ways that they are having problems and in some of these preventive measures would impact the progression of chronic health problems. But they aren’t able to think that kind of long term about it. I am hoping it has an impact on me being able to get on panels, so that is a really important piece.

 

Q: Do you think it will help you get on more panels?

A:  I really have no idea, and even my organization, my professional organization, isn’t sure.  There are kind of two camps: some believe that it is going to restrict services more because they are going to close down as much as they can on mental health plans. I had a client come, that supposedly still had insurance but did not have mental health benefits, and I was operating under the perspective that that was no longer legal. That mental health parity was reimbursable, they have to reimburse mental and physical at the same rate, but she went back to her insurance company and they said if they were not choosing the mental health services from the beginning, they didn’t have to cover it. I’m not sure what is going on there. There is some loophole allowing some people who have established health care to not have mental health, and it seems sketchy to me.

 

Q: Will there be any other loopholes with the insurance?

A: Oh, I am sure. I am sure it is the nature of human beings to find a way around, so the challenge is to get it tight enough that can be affective and not have that many loopholes. In other systems, in other countries when there is a single payer system or when there is a national health care where the majority of the people are covered or everyone is covered of some kind, it tends to get ride of the most egregious issues. When there are people with mental health needs and not having access to it or if people have pre-existing conditions and not being able to come and get mental health services. I think it is going to overall help.

 

Q: Do you think that some people will benefit more than others or do you think people will even take advantage of this mental health care?

A:  It is interesting because a colleague of mine, who graduated from the same program I did, I stayed in Michigan and she moved to Oregon. In Oregon the culture there is that people talk about having a health therapist all the time. They have a system in that state that makes it accessible and easy, also culturally in that state it does not have such at negative stigma. Something I’ve noticed in the Midwest, is that there are more reservations about admitting to go see a therapist or to say that that is part of my overall health. My point in that is that cultural matters. What society or region has to say about mental health issues and it impacts whether or not people go and take advantage of these services, and I think it is more cultural. But I think that national policy can have a dramatic impact on that, if everyone who’s on the news talks about “go to a therapist and deal with your stress so that you don’t get heart disease.” If that was the cool latest thing, and then we had access to health care, I’d have a full practice. But that is not millennium we live in.

 

Q:  If the narrative here changed do you think the demographic would also change?

A: Yeah, right now in our culture I think anything that our doctors sanction we will go do. And if we had mainstream medicine sanctioned mental health care, as a preventive approach, it would be happening in multiple sectors of society. Another interesting piece that is important to note when resources are limited in terms of mental health reimbursement as I would say they are; health insurance companies are restricting the number of providers and the amount of that they will provide for those providers. For Medicaid I get 50 dollars a sessions, what I charge is 150 dollars a sessions. Overhead billing takes 40 % of that of the 50 dollars and then I have to pay taxes, and you put me at the 30-35% tax’s bracket, and I am walking away with very little money. When resources are limited by the way health care is being managed, then these turf wars get started.

In the state of Michigan, Psychologists are fighting against master levels practitioners about getting reimbursed. So, at a state level they are making it really hard. So what happens?  Insurance companies and lobbyists at the state level are talking and the lobbyists at the state level are saying, “Do not in the state of Michigan reimburse master level practitioners, social workers, psychologists, or counselors for any mental health services.”  Blue Cross Blue Shield is saying, “okay” to that, so they are paying 200 dollar rate for psychology services, not allowing master level unless they were grandfathered in folks to be reimbursed, and think about the inefficiency of that. And how it’s inflating the amount on one end and its also causing turf war the levels of social workers, psychologist, counselors so they fight against each other, versus the idea that there is enough for everyone.

 

Q: So what do you each with insurance companies?

A:  It goes from 150 of what I get paid. But depending on the insurance company, I can get 150 from some; I’ll get a 120 from some, 100 or 80 from some. That is the other hard piece for someone like myself trying to manage how many people I can serve.  People begin to market to Blue Shield or Signa insurance because they reimburse more.  Financially it is smarter to get clients who have insurance who reimburse at a high rate.

 

Q: So it really makes an impact on how people run their business?

A: Definitely.  The people who are just managing to make a living are managing that to some degree. How many people can I take from this insurance and that insurance?

 

Q: What is the billing process like for you?

A: Well, now that I am in this new system, where 40% of what I earn goes away, it is easy. It goes to a person who spends their day talking to insurance companies to pay us and to make sure it is all correct, because if something is wrong it will get sent back and we will not get paid for another month.  But, if I were in France and a person just had a card with all of their health information on it, and they could come and just scan and I would get paid in three days. There are systems out there that can be more efficient. So, it was a rough transition from doing it myself to being within this practice and system. So going from out of pocket to taking insurance, I went three months without income while waiting to get reimbursed from all of those people I have been seeing. So, it was a hard transition. There has been time that I have not gotten paid because they have denied the claim.  For me, the issue is that to be a full provider, if you would go to your MD and they weren’t a provider for the insurance that you had, then your MD could say “I am not going to see you,” but I haven’t done that.

 

Q: Do you think that this insurance will make it less of a mess?

A: I am very hopefully. I am very hopefully and I know it will take a few years.

 

Q: Do you feel that people who are just going into getting Masters and social worker or counseling is diminishing?

A:  I am an advocate for master levels practitioners because my license is at the master levels; it’s not at the doctoral level. I believe that there are plenty of good people out there at the Master’s level and I believe that between 100-150 dollars for your services is an adequate amount to pay.  So, here is a great example of this, I had to change my primary care physician because he retired. And so, I was in the other day for something and I needed to do that, and they were like, “The only person that can see you is a nurse, if you’d want a doctor if would be a month before they can see you”, so I decided to see the nurse. Smart and wonderful women, one of the best kind of provider patient interaction that I had had. She was probably billing at half of the rate, or through another physician for her services. Why, she did a great job, she did everything I needed to do so I decided to choose her as my primary and I was able to do that. There is a certain level that nurses can provide, PA’s can provide, Master levels psychologist or counselors can provide, and then there is a need for more specialized people as well. So, the turf war stuff is unnecessary. There is more efficiency to be had when we recognize the different levels of practitioners.

 

Q: Any thoughts about the collaboration of Enroll Kalamazoo?

A: You know, oddly, I have not heard about it, but I have to do one copy out to that. I do not watch television, so if a lot of it came from the TV, I did not hear it. But I am a mental health provider in the county and I did not hear about it through mainstream sources. But, they may be targeting people that don’t have insurance, and I do, so that may be the difference.