Even with Insurance, It’s Getting Harder to Access Care

11/20/2019

Released today is an updated and expanded Milliman Report, “Addiction and Mental Health Vs. Physical Health: Widening Disparities in Network Use and Provider Reimbursement.” Since the last report two years ago, there has been an increase in coverage disparities for mental health and substance abuse disorders compared to other medical conditions related to physical health. Specifically, the report points out there is a shortage of in-network mental health care providers. And it also points out why: there is a lower incentive for a mental health care provider to take insurance as opposed to a primary care and specialty care provider. 

In 2017, primary care physicians received between 16.3% and 22.3% more than behavioral health care professionals for the same services. In summary, mental health providers are being reimbursed by insurance companies at a significantly lower rate than other providers — even if they are offering the same service. This inequity in reimbursement rates is a contributing factor to the vast number of mental health providers who do not accept any insurance and only see patients on an out-of-network basis.

One new area the report looked at is access to mental health care for youth. Recent CDC statistics show that youth suicides are at the highest rate in almost 20 years and unfortunately, this report shows that children are 10 times more likely to go to an out-of-network provider for a behavioral health care office visit than a primary care office visit which is more than twice the disparity seen for adults.  This situation will only lead to more lives lost due to lack of access to treatment and services. 

“You can’t have health without mental health. This report shows that Americans continue to face barriers to mental health care perpetuated by insurance companies, such as red tape and lack of in-network providers. The current situation is putting lives at risk,” said Angela Kimball, acting CEO of NAMI. “We need oversight, transparency and enforcement of parity to increase access to life-saving treatment.”

Insurance providers need to adequately staff mental-health-provider networks and equitably reimburse mental health care providers compared to primary care and specialty care medical/surgical providers. We need to put health plans on notice that they simply can’t make up the rules as they go along.