People seeking psychological treatment go out of network far more than those needing medical care, despite a law requiring parity.
More Americans turn to out-of-network providers when seeking mental health care than when seeking medical care, and the trend continues to worsen, a new study shows, despite a law designed to prevent this problem for people seeking treatment for conditions such as depression and addiction.
In an update of a landmark report about access to mental health treatment, researchers found that the disparity between medical coverage and mental and behavioral health coverage continued to grow in 2016 and 2017. In states like Connecticut, New York, and Maryland, patients were 10 times more likely to go out of network for behavioral health-care office visits than for primary care visits. This is a problem because out-of-network care is almost always more expensive.
“The study’s findings are beyond disappointing and disturbing,” says Henry Harbin, a psychiatrist and adviser to the Bowman Family Foundation, which commissioned the study. He had expected to see an improvement in patients being able to access in-network care, rather than the opposite.
The Milliman study looked at 2016 and 2017 claims data from 50 states and hundreds of health plans that insure 37 million people. Patients are more likely to use out-of-network care options for any kind of mental health service: in-patient, outpatient, and office visits. For example, a person is 5.2 times more likely to use an in-patient facility that doesn’t take their insurance for a behavioral health problem than for a medical or surgical issue, up from 2.8 times in 2013. A person with a behavioral health condition was 5.4 times more likely to go out of network for an office visit in 2017, up from 5 times in 2013, the study shows.
“This report is a scathing indictment of the insurance industry’s lack of initiative and dedication to addressing this crisis head on,” says Patrick Kennedy, a former congressman who introduced the law requiring better insurance coverage for mental health. He sent a letter to House Energy and Commerce Committee Chairman Frank Pallone and House Education and Labor Committee Chairman Bobby Scott urging hearings on the issue of insurance access to mental health care based on the Milliman findings.
“The problem is urgent and needs everyone’s attention,” says American Psychiatric Association CEO Saul Levin. The APA pointed out this survey is of insurance offerings that are considered “Cadillac plans” for their generous benefits. “If a plan charges a patient for a product – access to mental health and substance use disorder treatment – and then ensures through its business model that there will be no providers to deliver that treatment – it is an unfair and deceptive trade practice.”
The report also shows that medical and surgical providers received higher in-network reimbursement rates than behavioral health providers for similar work. Primary care doctors, were paid as much as 23.8% more than a mental health professional for a comparable appointment in 2017. “So many mental health professionals are not seeing new patients in-network, or they’re coming out of med school and being essentially guided that they shouldn’t participate in the networks,” says Michael Thompson, chief executive officer of the National Alliance of Healthcare Purchaser Coalitions, which represents 12,000 employers that provide health insurance for 45 million people. “It’s really the people in crisis—newer patients—that are having serious access problems.”
The study’s authors looked at the utilization of out-of-network care for children’s behavioral health problems and found that in 2017 it was 10 times more likely that a child would go out of network for behavioral health-care office visits as opposed to for primary care, more than double the ratio for adults.
“This report shows that Americans continue to face barriers to mental health care perpetuated by insurance companies, such as red tape and lack of in-network providers,” says Angela Kimball, acting CEO of the National Alliance on Mental Illness. “The current situation is putting lives at risk.”