Harbin, now a consultant on parity issues, said the report's finding that mental health providers are paid less than primary care providers is a particular surprise. In nine states, including New Hampshire, Minnesota, Vermont, Maine and Massachusetts, payments were 50 percent higher for primary care providers when they provided mental health care.
Because of such low reimbursement rates, he said, mental health and substance abuse professionals are not willing to contract with insurers. The result is insurance plans with narrow behavioral health networks that do not include enough therapists and other caregivers to meet the demands of patients.
For years, insurers have maintained that they are making every effort to comply with the Mental Health Parity and Addiction Equity Act, which was intended to equalize coverage of mental health and other medical conditions. And previous research has found that they have gone a long way toward eliminating obvious discrepancies in coverage. Most insurers, for example, have dropped annual limits on the therapy visits that they will cover. Higher copayments and separate mental health deductibles have become less of a problem.
Still, discrepancies appear to continue in the more subtle ways that insurers deliver benefits, including the size of provider networks.
Kate Berry, a senior vice president at America's Health Insurance Plans, the industry's main trade group, said 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 shortage areas, said 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."
"This is a challenge that no single stakeholder in the health care infrastructure can solve," she added.
Carol McDaid, who runs the Parity Implementation Coalition, countered that insurers have been willing and able to solve provider shortages in other fields. When there was a shortage of gerontologists, for example, McDaid said, insurers simply increased the rates and more doctors joined the networks. "The plans have the capacity to do this; I just think the will hasn't been there thus far," she said.
The scarcity of therapists who accept insurance creates a care landscape that is difficult to navigate for some of the most vulnerable patients.
Ali Carlin, 28, said she used to see her therapist in Richmond, Va., every week, paying a copay of $25 per session. But in 2015, the therapist stopped accepting her insurance, and her rate jumped to $110 per session.