Wednesday, April 17, 2024

Access to In-Network Mental Health Care Still Lags Far Behind Other Medical Care

Patients are far more likely to go out of network to obtain health care from mental health professionals than from medical or surgical professionals, a report by RTI International has found.

In research that was partially funded by APA, Tami L. Mark, Ph.D., M.B.A., and William J. Parish, Ph.D., M.A., analyzed enrollment data and claims from more than 22 million individuals captured annually from 2019 through 2021 to evaluate out-of-network use and reimbursement rates across all 50 states.

The researchers found that patients went out of network 3.5 times more often to see a behavioral health professional (physician or nonphysician) than to see a medical or surgical professional. Patients went out of network 8.9 times more often to see a psychiatrist than another specialty physician, and 6.9 times more often to see a psychiatrist than a primary care physician.

The researchers also found that reimbursement for an in-network office visit was 22% higher for medical and surgical professionals than office visits with behavioral health professionals. Notably, physician assistants were reimbursed for office visits an average of 19% higher than psychiatrists, while nurse practitioners were reimbursed about 8% higher than psychiatrists.

Mark and colleagues concluded that shortages of behavioral health professionals do not explain the disparities in out-of-network use and reimbursement. “The finding of large disparities for out-of-network use and reimbursement rates highlights that health plans are not using the same measures to improve the adequacy of their behavioral health provider networks as they do for medical networks,” Mark said in a statement.

“The report’s findings make it clear that health insurers must be held accountable for not complying with the Mental Health Parity and Addiction Equity Act and provide appropriate payment for the care offered by psychiatrists and other mental health professionals,” said APA CEO and Medical Director Saul Levin, M.D., M.P.A. “Enforcing parity will increase participation in insurance plans among mental health professionals and therefore increase access to mental health care by making those services more affordable for patients.”

The researchers recommended that federal and state agencies develop standardized templates to identify and remedy parity violations. They outlined several methods for developing these templates, including the following:

  • Comparing behavioral health and medical/surgical reimbursement rates using Medicare benchmarks to allow valid and accurate comparisons across the array of services.
  • Evaluating reimbursement disparities by specific provider type.
  • Using all procedure billing codes when evaluating out-of-network use and reimbursement disparities, and not just a few selected codes.

For related information, see the Psychiatric Services article “Patients’ Reasons for Using Out-of-Network Mental and General Medical Health Providers.”

(Image: Getty Images/iStock/courtneyk)

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