Why won’t insurance companies pay for SC kids’ school counseling? Panel demands answers
A panel of South Carolina lawmakers wants private health insurance companies to explain why they don’t cover mental health counseling provided in schools.
The Joint Citizens and Legislative Committee on Children, which Tuesday was briefed on the state’s shortage of school-based therapists and the surprise bills some families are getting for in-school counseling, will ask the state’s insurance providers to testify at the committee’s next meeting later this month.
The request comes as the panel considers a legislative proposal that would prohibit health insurance companies from denying claims for mental health services solely because those services are provided in school.
Gov. Henry McMaster recently ordered a review of South Carolina’s school-based mental health services program after learning that some families with private insurance had been billed hundreds or even thousands of dollars for in-school counseling.
While children on Medicaid or the state’s health plan pay nothing for school-based mental health services and uninsured children pay on a sliding scale determined by family income, many private insurance plans, including ones that cover counseling at mental health centers or at home, won’t pick up the tab if services are administered at school.
The reason insurers deny school-based claims, committee attorney Shealy Reibold explained, is that they don’t want to pay for something they believe the state should cover.
“Insurance companies, from what I understand, are afraid of that slippery slope that suddenly schools will start billing everything — all the services that they provide in the school-based setting — to private insurance,” she said.
To get around those insurance denials, state lawmakers could pass legislation similar to what three other states have adopted in recent years prohibiting private insurers from denying payment for mental health services they otherwise would have covered had those services not been delivered in schools, Reibold said.
The laws passed in other states apply only to insurance plans that already cover school mental health services provided in a clinician’s office or via telehealth, so they don’t completely eliminate the billing problem for all families. But they do have an impact, she said.
An analysis of South Carolina behavioral health benefit data found that if a similar bill were enacted here it would cover 35,000 additional children, Reibold said.
There are about 780,000 public school students enrolled in the state, roughly 20,000 of whom receive school-based mental health services each year, according to state Department of Mental Health data.
“We’re still gonna have a large number of children who are not covered because their insurance policies aren’t governed by state law … or their health insurance does not cover mental health services to begin with,” she said.
The roughly 50,000 children in the state who are uninsured would also still have to pay for services out of pocket, albeit likely at a reduced rate, and insurance providers could still deny claims if they opted not to make the Department of Mental Health or any third party contracted by the agency an eligible provider, Reibold said.
Senate Minority Leader Brad Hutto, D-Orangeburg, said the failure of insurance companies to reimburse for school-based mental health services didn’t seem fair, but suggested the committee invite insurance representatives to justify their denials of coverage before introducing any legislation.
“Maybe there’s a good reason that we don’t know,” he said. “Although we don’t see it right now.”
The committee’s next hearing, where health insurance providers and school district representatives are expected to testify, is tentatively set for late February.
DHHS reviewing school-based mental health services
The governor’s review of school-based mental health services, which the state Department of Health and Human Services is leading, is expected to take about 90 days, DHHS Director Robbie Kerr testified Tuesday.
Kerr said the governor approached the agency several weeks ago with concerns about the sharp drop in school-based mental health clinicians, the reduction in students receiving school-based counseling and the large bills some families had gotten for services.
Health and Human Services officials are gathering information from schools and the Department of Mental Health, which employs many school-based clinicians, to better understand the barriers to access and remedy those barriers, he said.
To meet the growing demand for school-based mental health counseling, Kerr said the state should consider hiking clinician salaries — DMH’s master’s-trained therapists earn less than $40,000 to start — and setting less stringent qualifications for them.
“If we set standards excessively high we’re gonna just exacerbate that problem,” he said. “So where can we find the happy medium to have proper quality, but still encourage enough people to enter the field that we can meet the need?”
Kerr said the ultimate goal is to ensure that students no longer face financial barriers to access and that school districts have a slate of mental health providers at their disposal.
The core question, he said, is whether the state or private insurance and individuals will ultimately be on the hook for the services.
Sen. Katrina Shealy, R-Lexington, said at Tuesday’s hearing she didn’t think the state should charge children for school-based counseling because it precludes some kids from getting the help they need.
“I think we’re kind of picking and choosing who’s gonna get mental health care then,” she said.
This story was originally published February 2, 2022 at 9:20 AM.