A report out this week found that people seeking mental health treatment go out-of-network more than they do for primary care. Essentially, that means that for consumers, it’s often more expensive to treat mind than body, and the disparity seems to have gotten worse in recent years.
“People have to go out of network, which usually means they have to pay more out of pocket if they want mental health and substance use services,” said Steve Melek, an actuary with Milliman, a risk management and healthcare consulting company that wrote the report.
And that, in turn, can put behavioral health help out of reach for a lot of people. This latest report adds two years of data to an earlier one that looked at claims in 50 states from 2013 to 2015.
“Almost all of these disparities got worse, despite the fact that we all know there’s an access problem with mental health and substance abuse providers in-network, and that we have a massive epidemic of suicides and deaths from opiates and other substances,” said Henry Harbin, a psychiatrist and an adviser to the Bowman Family Foundation, which commissioned the report.
Among the findings about office visits in 2017:
- Montana and Colorado were among the 11 states with the largest disparities. People there were about 9 times more likely to go out-of-network for behavioral health office visits than for primary care office visits.
- In Nevada, people were about 4 times more likely to go out-of-network for behavioral health office visits than for primary care office visits.
- In Idaho, Wyoming, Utah and New Mexico, people were about twice as likely to go out-of-network for behavioral health office visits than for primary care office visits.
It isn’t supposed to be this way. As NPR reported when the previous report came out, the 10-year-old Mental Health Parity And Addiction Equity Act “promise[d] to make mental health and substance abuse treatment just as easy to get as care for any other condition. Yet today, amid an opioid epidemic and a spike in the suicide rate, patients are still struggling to get access to treatment.”
And as Melek points out, this report looked at claims -- so it only reflects people who actually received services.
“People that identify that they have to go out-of-network and then they get an estimate of the bill and they say, ‘That’s too expensive, I’m not gonna do it,’ we don’t even know about those people,” said Melek.
So, he added, the findings are “an understatement” when it comes to the challenges of receiving care for mental health or addiction.
As NPR reported in 2017:
“Kate Berry, a senior vice president at America's Health Insurance Plans, the industry's main trade group, says the real problem is the shortage of behavioral health clinicians.
Health plans are working very hard to actively recruit providers and offer telemedicine visits in areas with shortages, says Berry. "But some behavioral health specialists opt not to participate in contracts with providers, simply because they prefer to see patients who are able to pay out of their pocket and may not have the kind of severe needs that other patients have."
A spokesperson with AHIP said Berry’s comments still hold true. But Harbin said the issue isn’t just about clinician shortages.
For example, when it came to inpatient care, a number of states in the Mountain West did better than states with much larger populations of mental health providers.
“Pretty rural states like Wyoming and North Dakota and Idaho were doing pretty good compared to medical,” said Henry Harbin, referring to 2017 data from all 50 states. “Which is interesting because these are states that are sparsely populated by professionals of all types.”
By comparison, states like California and New York, which are chock full of mental health professionals, did worse. There, people tended to go out-of-network for behavioral care a lot more than they did for other types of care.
Harbin said making it easier for people to get help for behavioral issues isn’t just about having more professionals around -- those professionals also need to get reimbursed more.
“The health plans and the employers that hire them have done a pretty good job of keeping the out-of-network use for medical and surgical providers very low, and there are many shortages of primary care doctors in certain states, yet their out-of-network use is only 3 or 4% in many situations, whereas behavioral is 10, 20, 30%,” said Harbin. “My challenge to the health plans and employers that hire them is: Just do what you’re doing with medical colleagues for the behavioral people.”
Among the findings about reimbursement rates for office visits in 2017:
- Idaho was among the 11 states with the worst disparity on this front. Reimbursement rates for primary care were 55% higher than those for behavioral health.
- In Wyoming and Colorado, reimbursement rates for primary care were more than 30% higher than those for behavioral health.
- In Utah, reimbursement rates for primary care were about 30% higher than those for behavioral health.
- Nevada was among a small group of just three states that actually did well on this front. There, reimbursement rates were better for behavioral health than for primary care.
This story was produced by the Mountain West News Bureau, a collaboration between Wyoming Public Media, Boise State Public Radio in Idaho, KUER in Salt Lake City, KUNR in Nevada and KRCC and KUNC in Colorado.