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If your insurer covers few therapists, is that really mental health parity?

Jenny Gold, Kaiser Health News on

Published in Health & Fitness

It's been nearly a decade since Congress passed the mental health parity act, with its promise to make mental health and substance abuse treatment just as easy to get as care for any other condition. Yet today, in the midst of the opioid epidemic and a spike in the rate of suicide, patients still struggle to access treatment.

That's the conclusion of a report published last week by Milliman Inc., a national risk management and health care consulting company. The report was released by a coalition of mental health and addiction advocacy organizations.

Among the findings:

-- In 2015, behavioral care was four to six times more likely to be provided out-of-network than medical or surgical care.

-- Insurers pay primary care providers 20 percent more for the same types of care as they pay addiction and mental health care specialists, including psychiatrists.

-- State statistics vary widely. In New Jersey, 45 percent of office visits for behavioral health care were out-of-network. In Washington D.C., the figure was 63 percent.

 

The researchers at Milliman examined two large national databases containing medical claims records from major insurers for PPOs -- preferred provider organizations -- covering nearly 42 million Americans in all 50 states and the District of Columbia from 2013 to 2015.

"I was surprised it was this bad. As someone who has worked on parity for 10-plus years, I thought we would have done better," said Henry Harbin, former CEO of Magellan Health, a managed behavioral health care company. "This is a wake-up call for employers, regulators and the plans themselves that whatever they're doing, they're making it difficult for consumers to get treatment for all these illnesses. They're failing miserably."

The high proportion of out-of-network behavioral care means mental health and substance-abuse patients were far more likely to face the high out-of-pocket costs that can make treatment unaffordable, even for those with insurance.

In a statement issued with the report, the coalition of mental health groups, including Mental Health America, the National Association on Mental Illness, and The Kennedy Forum, called on federal regulators, state agencies and employers to conduct random audits of insurers to make sure they are in compliance with the parity law.

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