Patients with private insurance who saw behavioral health professionals went out-of-network for their care more often than their peers who received care from medical or surgical health professionals, according to a study published today in Psychiatric Services.
Tami L. Mark, Ph.D., of RTI International, and colleagues analyzed deidentified health insurance claims data from 22.8 million individuals in the Merative MarketScan Commercial Database who had private insurance in 2021. They compared the percentage of out-of-network claims for behavioral health providers with the percentage of out-of-network claims for medical and surgical providers across four settings: inpatient facilities, subacute inpatient facilities, outpatient facilities, and office visits to independent practitioners.
Across all settings, patients with substance use disorder (SUD) were most likely to go out-of-network for care, followed by those with a mental disorder and those who received medical or surgical care. For example, the percentages of out-of-network encounters in acute inpatient facilities such as hospitals were 18.1% for SUD, 4.3% for mental disorders, and 1.5% for medical or surgical treatments. The percentages of out-of-network encounters in subacute inpatient facilities such as residential settings were 35.9% for SUD, 31.7% for mental disorders, and 1.7% for medical or surgical treatments.
“Our finding of greater use of out-of-network behavioral health providers versus medical or surgical providers is consistent with findings from other studies in which researchers used different methodologies (e.g., secret shopper calls, employer surveys, consumer surveys, and provider network analyses) that showed that consumers have limited access to in-network behavioral health providers,” the researchers wrote. “Health plans have strategies to increase providers’ network participation, such as increasing reimbursement rates, reducing the administrative inconveniences of joining a health plan, and reducing the administrative burden of being paid by a health plan.”
For related information, see the Psychiatric News article “Access to In-Network Mental Health Care Still Lags Far Behind Other Medical Care.”
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