In the midst of an opioid epidemic and increased suicide rates, Coloradans are finding it increasingly difficult to access affordable mental health and substance use care under their private insurance plans. A nationwide study by the actuarial firm Milliman sheds light on this trend over a five-year period beginning in 2013—which documents widening disparities in access to in-network services for mental health and substance use disorder treatment among 37 million employees and their families.
“The Milliman report confirms that even so-called good health insurance is no guarantee of access to care for mental health and substance use disorder needs,” said Vincent Atchity, president and CEO of Mental Health Colorado. “People with what’s thought to be good insurance discover, in their times of greatest need, that their provider networks are wholly inadequate. If they can find care at all, they have to pay for it out of pocket, at great cost.”
Milliman’s latest report shows that access to in-network care has continued to decline since 2013. Through its review of claims data from hundreds of health insurance plans nationwide, the report finds that:
- Despite the national opioid and suicide crises, mental health and substance use care together accounted for less than 3.5% of total health care reimbursement, with substance use care ranging from 0.7 to 1% of that total over the 5-year period.
- Mental health access disparities escalated from 2013 to 2017 in all three categories of care examined: outpatient visits, inpatient facilities, and outpatient facilities. Disparities nearly doubled for inpatient and outpatient facilities, rising from almost 3 to nearly 6 times more likely that patients need to seek care out of network, when compared to medical/surgical facility use.
- Children were 10 times more likely to receive outpatient mental health care out of network compared to primary care visits, twice the disparity faced by adults.
The report also documented a substantially lower reimbursement rate for mental health office visits compared to primary care reimbursement for similar billing codes, based upon Medicare payment levels. While provider shortages have been addressed on the medical side through higher reimbursement, health insurers continue to pay mental health providers less than Medicare allowable rates.
Key findings in Colorado, include:
Among outpatient office visits in 2017, behavioral healthcare visits were nearly 10 times more likely to be out-of-network as compared to primary care visits.
Between 2013 and 2017, out-of-network use for inpatient facilities ranged 3 to 7 times higher for behavioral healthcare than for medical/surgical services.
For outpatient facilities, out-of-network use ranged 3 to 7 times higher for behavioral health than medical/surgical care between 2013 and 2017.
In-network medical/surgical specialists were paid 37% more than in-network behavioral healthcare providers, each relative to Medicare-allowed amounts, for 2017.
”Just because mental health parity exists in statute does not mean it exists in reality,” Atchity said. “Existing laws regarding network adequacy and reimbursement rates must be enforced. Consumers and employers who purchase private insurance plans must demand real coverage and real access to care. Additional legislation and legal action may be required, and penalties may have to be imposed, to compel insurers to provide true equality of coverage and access for mental health care.”