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Report Finds Big Disparities in Mental Health Payments, High Out-of-Network Usage

By Gregory A. Freeman  
   December 04, 2017

For behavioral health, 18.7% of office visits were accessed out-of-network, while only 3.7% of primary medical/surgical office visits were accessed out-of-network.

Also, 16.7% of inpatient facility behavioral health care was accessed out-of-network, while only 4.0% of inpatient facility medical/surgical care was accessed out-of-network.

The numbers tell a painful story for those seeking treatment for mental illness or addiction, says Mary Giliberti, CEO of the National Alliance on Mental Illness.

"Behind those numbers are millions of Americans who can't get the care they desperately need,” she says. “We are confident that this Milliman analysis has uncovered a key barrier to network access—unfairly low reimbursement payments to mental health and addiction providers.”

As of 2015, out-of-network use of behavioral health inpatient care—as compared to medical care—was about 800% higher in California, New York, and Rhode Island, and over 1,000% higher in Connecticut, Florida, New Jersey, Pennsylvania, and New Hampshire, the report says. These states collectively had a population representing 30% of the U.S. population.

In 2015, there were 24 states with reimbursement disparities ranging from 30% to 69%, including Washington, Kentucky, and Virginia.

American Psychiatric Association CEO and Medical Director Saul Levin, MD, MPA, says the report indicates insurers are not maintaining adequate mental health provider networks and psychiatrists are reimbursed less than primary care doctors for the same services.

“We call upon state and federal regulators," he says, "to ensure that insurance companies are abiding by parity laws already on the books to correct what remains an unequal health care system for patients with behavioral health conditions."

Gregory A. Freeman is a contributing writer for HealthLeaders.

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