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Private Insurer’s Noncompliance Means Patients Still Pay More Out-of-Pocket for Mental Health Care

A powerful report by Milliman confirms insurers are not complying to federal law established by the Mental Health Parity and Addiction Equity Act of 2008.
The failure of private insurance companies to comply with the law and cover mental health care equally is leading to an inability for people to get vital treatment.
study published in November 2017, identifies continuing disparities in both out-of-network utilization and reimbursement rates for medical/surgical providers in comparison to behavioral providers.
What does this mean to the average person?
When insurance plans do not reimburse providers adequately, fewer providers choose to participate in the plans’ networks. In-network care typically has lower member copays or coinsurance requirements compared to out-of-network benefits.

So, someone may make a decision to seek help — but be unable to find a provider in the network who doesn’t have a six-month wait or require a two-hour drive each way. If they cannot find treatment at the time they need it, or find a provider facility to which they have the means to travel, they will face the need to go out-of-network, resulting in higher out-of-pocket costs.

Key findings from the study for Georgia:
  • In 2015, Out-of-network office visits for behavioral care in Georgia took place more than 4X more frequently than out-of-network office visits for primary care or specialists.
  • In 2015, primary care services were paid 36.6% higher as compared to behavioral services, and specialist services were paid 32.6% higher as compared to behavioral services.
This study was commissioned by the Mental Health Treatment and Research Institute LLC, a not-for-profit subsidiary of The Bowman Family Foundation. The study itself was prepared by Milliman, among the world’s largest providers of actuarial and related products and services.



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