Demand for mental healthcare services has long exceeded the supply of clinicians. And stakeholders say many patients still face challenges accessing care more than a decade after enactment of the landmark Mental Health Parity and Addiction Equity Act of 2008, which was meant to address that issue.
The law was instrumental in ending many restrictions imposed on mental health and addiction treatment, such as stricter limits on the number of patient visits for such services and separate, often higher deductibles and out-of-pocket costs compared with other medical services.
But it remains difficult for those with commercial insurance to access mental healthcare services, according to Charles Ingoglia, CEO of the National Council for Behavioral Health. He said many patients with private coverage struggle to find a provider that accepts their health plan.
Studies have pointed to a widening access gap between behavioral health patients and those needing medical or surgical care.
Those seeking inpatient behavioral healthcare were 5.2 times more likely than medical patients to go out of network for services in 2017, compared with 2.8 times more likely in 2013, according to a report published in November by actuarial firm Milliman. Similar disparities were found for those seeking outpatient treatment; out-of-network use of behavioral services increased from being three times more likely than medical care in 2013 to 5.7 times by 2017.
“There’s really nobody looking at the state of network adequacy when it comes to private health plans,” Ingoglia said.
Consequently, as patients get more of their behavioral healthcare services from out-of-network providers, their out-of-pocket expenses for care grow.
While mental and substance use disorders were associated with lower total healthcare expenses than health conditions like congestive heart failure or diabetes, behavioral health patients had higher out-of-pocket costs, on average paying $341 more per year than patients with diabetes, according to a study JAMA Network Open published in November.
Ingoglia said commercial insurers’ low reimbursement rates for behavioral healthcare services gave providers little incentive to accept insurance for mental healthcare, further shrinking the number of mental health clinicians available to patients relying on insurance.
A Congressional Budget Office analysis that Health Affairs published in 2019 found commercial plans on average paid 14% less than fee-for-service Medicare for the same in-network mental healthcare services despite paying 12% more than Medicare for the same services when provided by other medical specialties.
Both problems have resulted in a smaller pool of healthcare professionals available to treat new patients. Behavioral healthcare providers have one of the lowest participation rates in health insurance of any medical specialty, with 55% of psychiatrists accepting commercial health plans, 54% accepting Medicare for payment and 43% accepting Medicaid in 2010, according to a 2014 study published in JAMA Psychiatry.
“That’s a parity problem in two different ways,” Ingoglia said.
