Behavioral care more likely to be out of network than physical care

Patients are significantly more likely to go to an out-of-network provider when seeking behavioral care than when seeking medical or surgical care, according to a study conducted by Milliman and commissioned by the Mental Health Treatment and Research Institute.  

Researchers found patients in the inpatient setting were 2.8 to 4.2 times more likely to receive care from an out-of-network provider for behavioral health services than for medical or surgical services. In the outpatient setting, the differential was even greater. Behavioral health services in the outpatient setting were 3 to 5.8 times more likely to be out-of-network than physical care services. For office visits, behavioral health was 4.8 to 5.1 times more likely to be out of network than a primary care office visit.

The study also found medical-surgical providers were reimbursed more than behavioral health providers for similar services. For example, primary care providers received 20.7 to 22 percent more for office visits than behavioral health providers. Lower reimbursement discourages behavioral health providers from participating in networks, and ultimately lowers access to care for patients who cannot afford to pay out-of-network rates, according to the report.

Some states perform better than others in terms of in-network access to behavioral health providers. For example, Nebraska was the only state in 2015 to report fewer out-of-network behavioral office visits than primary care visits. On the other end of the spectrum was Connecticut, where patients seeking behavioral health in an office setting were 10.4 times more likely to go out of network than patients in primary care office visits.

These differences suggest several explanations, according to the researchers. Patients in some states may be more reluctant to switch to in-network providers. There may be fewer behavioral health providers in some states, limiting supply. Or network design may differ from state to state.


More articles on payer issues:

Iora Health physicians join UnitedHealthcare's Medicare Advantage network
Anthem joins Colorado's Medicaid alliance
Einstein Healthcare Network signs value-based payment agreement with Humana

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