Behavioral Health Access Worsening for Employer-Sponsored Health Plans

November 24, 2019

Disparities between network use and provider reimbursement levels widening, report finds.

Disparities between out-of-network use of behavioral healthcare benefits and physical healthcare benefits have increased between 2015 and 2017, according to a new report from Milliman, Inc. and The Bowman Family Foundation.

The report, “Addiction and Mental Health vs. Physical Health: Widening disparities in network use and provider reimbursement,” published by Milliman, Inc., and commissioned by The Bowman Family Foundation, reflects that conditions have worsened since a similar study was published two years ago. It shows the gap in disparities for employees and their families seeking mental health and addiction treatment versus treatment for physical health conditions widened in 2016 and 2017.

The study, based on actual claims data in all 50 states for hundreds of health insurance plans, demonstrates that “out-of-network” use of behavioral providers is higher than out-of-network use of medical and surgical providers. The degree of disparity has grown substantially in recent years, despite state and federal efforts to promote parity. The study also documented much lower reimbursement rates paid by insurers to behavioral providers for “in-network” services, with the gap between behavioral versus medical/surgical providers widening. 

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According to the report, nationally, out-of-network use of behavioral healthcare benefits is over five times that of physical healthcare benefits for inpatient hospital, outpatient hospital, and professional office-based services in 2017. Additionally, differences between provider payment levels for physical healthcare office-based services and behavioral healthcare services have widened such that primary care and specialty medical providers receive payments for office-based services that are 24% higher than payments received by behavioral healthcare providers.

“[The study] provides insight into potential parity compliance issues regarding network adequacy and provider payment levels between physical healthcare and behavioral healthcare benefits,” says Seve Melek, principal and consulting actuary at Milliman, and one of the report’s co-authors.

The report also found that out-of-network use for substance use disorder benefits are nine to 10 times as high as physical healthcare benefits in 2017. Out of network use rate for behavioral healthcare office-based benefits for children are 10 times as high as physical healthcare office-based benefits.

 

“Our findings indicate that disparities exist in both network use and provider reimbursement level when comparing behavioral healthcare to medical/surgical healthcare,” Melek says. “While MHPAEA [Mental Health Parity and Addiction Equity Act] federal rules state that disparate results are not in and of themselves definitive evidence of noncompliance, significant disparities, such as high out-of-network use of behavioral health providers and/or lower reimbursement for behavioral providers, could point to compliance problems. Health plans should carefully review their processes in order to ensure compliance.”