The worsening state of mental health coverage: 3 takeaways

Disparities between coverage for behavioral health services and medical/surgical services are widening, according to a research report from consulting firm Milliman.

The Mental Health Treatment and Research Institute, a subsidiary of the Bowman Family Foundation, commissioned the report. Researchers examined third-party administrative claims data to determine if coverage for behavioral healthcare services was limited. The report considers claims from 2013-17.

Three key takeaways:

1. More consumers accessed out-of-network behavioral healthcare providers than out-of-network medical/surgical providers in the five-year period. The disparity between how often consumers accessed out-of-network behavioral inpatient facilities compared to out-of-network medical/surgical inpatient facilities grew 85 percent in the period.

2. Reimbursement continued to lag for behavioral healthcare services. In 2017, primary care reimbursements were 23.8 percent higher than reimbursements for behavioral health providers.

3. Disparities also increased among consumers who accessed out-of-network substance misuse inpatient facilities. In 2013, consumers were 4.7 times more likely to access an out-of-network substance misuse inpatient facility than an out-of-network medical/surgical inpatient facility. In 2017, consumers were 10.1 times more likely to do so.

"Our findings indicate that disparities exist in both network use and provider reimbursement level when comparing behavioral healthcare to medical/surgical healthcare," the researchers said. "While [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."

Read the full report here.

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