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Dear CEOs and HR Directors,

I know you’re all very busy: I’ll try to be brief. I'm writing to you today about your employees’ health insurance. First, in general, I want to say that you’re doing a great job. Running a successful organization isn't easy, nor is figuring out what’s working, or not, with your employee benefits. All I’m asking is that you hear me out about something important that is overlooked by many leaders.

You see, I work in a psychiatry practice. Believe it or not, for the past decade, I have been meeting your employees and colleagues daily—at my job! I know that might surprise you. You may not imagine that, behind the well-crafted resumes and pedigrees, some of your personnel—sometimes the same ones who meet quotas, close deals, and bust through performance goals—have formidable struggles that you don’t always see at work.

Or maybe you do.

Maybe you are already aware of the kind of inter- and inner-personal snags that can show up in the workplace, such as trouble meeting deadlines, poor stress management, and petty but energy-sucking difficulties with coworkers or clients. Maybe you already experience absenteeism, even when your employees are present and accounted for. Or you're aware of the gap between what’s possible for your team and what’s produced and delivered. Perhaps you’re familiar with the struggles a rock-solid performer (maybe even you?) faces when she’s preoccupied with hard times at work or at home.

If your choice of insurance company has few mental health providers, or your plan has such a high deductible that your employees can't afford to meet the out-of-pocket costs, having insurance isn't much different than not having insurance.

I’ve got great news for you! Your people are reaching out for professional help with their mental health issues! Who knew? Your very own employees have done their research, booked appointments, shown up, filled scripts, and established a treatment alliance with a professional who can help them. You have no idea how courageous your employees are, how ready they are to face and tackle their problems. You would be amazed. I know I am.

Unfortunately, I have bad news, too. Your mental health coverage stinks. I know because I’ve seen your choices about health care in action. When one of your employees is informed that their mental health care benefits are negligible to non-existent, I see all the courage I just described replaced by absolute despair.

I have seen employees with no coverage, skimpy coverage, and coverage outsourced to a separate "carve out" carrier who promises financial savings. I’ve seen really, really bad contracts from companies whose provider networks consist of a bunch of crickets. I’ve seen huge deductibles. To be fair, I've seen generous coverage, too—flex spending accounts, health savings accounts, health reimbursement accounts, and employees whose care is covered 100%. More and more, I see companies who so value mental and behavioral health that they pay an additional amount, above and beyond the medical coverage, to a liaison who makes sure their employees get care from an EAP or private provider. I have hunted down and negotiated provider agreements, just so a single employee can afford to continue to build the relationship they have so hopefully begun. But everyone has limits. You have invited me to some scary places, contract-wise, where I just will not go.

I know benefits are expensive, but if you strive too hard to save money on your employees' health insurance, it's possible that you're actually just wasting your money. If your choice of insurance company has few mental health providers, or your plan has such a high deductible that your employees can't afford to meet the out-of-pocket costs, having insurance isn't much different than not having insurance.

Do I have a neat and tidy solution to this problem, for all businesses? I don’t. But I do have a request that may help. The next time you choose your employees’ insurance, please ask these questions: How many mental health providers are in Company X’s network? And what kind of providers are they? Look for a range of psychiatrists, psychologists, psychiatric nurse practitioners, social workers, and therapists. If an insurer has a broad range of providers, that's a good sign that they value mental health care.

What is the true difference in cost between companies with more or less robust mental health coverage?

If your business contributes to the cost of your employees' health care, it’s tempting to go with the least expensive plan. But when you add up the costs, you must consider those associated with having no mental health care, or mental health care that's available, but for which there are few (or no) providers. Think about how mental health affects your employees’ performance—and how that performance affects your bottom line. Think, also, about how your investment in more comprehensive coverage enables you to compete with other employers in your industry. According to a 2003 study of a random sample of over 28,000 workers by Stewart, et al, mental illness and substance abuse costs U.S. employers an estimated $225.8 billion each year. The largest indirect cost of mental illness comes in the form of decreased performance due to absenteeism, or regularly missing work, and presenteeism, or working while sick.

How does a prospective insurance company encourage employees to access mental health care?

Some companies have additional programs, such as hotlines and referral assistance, to assist employees in choosing the right provider. You also want a prospective insurer to be able to demonstrate how their particular system makes the connection between proactive mental health support and medical care cost savings. It's hard to exert the energy to address a health problem when you're anxious, depressed, or struggling with even more serious issues.

When your employees reach out for professional help with a problem, your choices can make all the difference. I urge you to think of comprehensive health coverage as an investment, not just a cost.



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