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Analysis

Mental Health Services Far More Likely to be Delivered by Out-of-Network Provider

By Alexandra Wilson Pecci  
   June 01, 2020

Provider directory inaccuracies for mental health providers often lead to out-network-care and surprise bills, illuminating need for federal standards, the authors say.

Out-of-network care is especially common among mental health services, and part of the reason for that is out-of-date provider directories.

That's according to a new study in the June issue of Health Affairs, which showed that mental health services are "up to six times more likely than general medical services to be delivered by an out-of-network provider."

Not only do many psychiatrists not accept commercial insurance, but provider directories that are supposed to help patients identify in-network providers are often inaccurate, the researchers said.

In their national survey of privately insured patients who received specialty mental health treatment, they found that "44% had used a mental health provider directory and that 53% of these patients had encountered directory inaccuracies."

Encountering a directory inaccuracy led to those patients being more likely (40% versus 20%) to be treated by an out-of-network provider and four times more likely (16% versus 4%) to receive a surprise bill.

The most common provider directory problems were:

  • A provider incorrectly listed as taking new patients (36% of participants)
     
  • A provider listed that did not accept their insurance (26% of participants)
     
  • A provider's contact information being incorrect (24% of participants)
     
  • A provider listed as taking new patients but was not taking patients with their problem or condition (20% of participants)
     
  • Inaccuracies in either contact information or network participation (36% of participants)

"A federal standard for directory accuracy, stronger enforcement of existing laws with insurers liable for directory errors, and additional monitoring by regulators may be needed," the authors concluded.

Alexandra Wilson Pecci is an editor for HealthLeaders.


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