Nicholas Burt, LMFT
Disparity in Mental Health Reimbursement and Network Use
It can be even more difficult to be fairly reimbursed for your treatment. This problem was recently supported by a research report from Milliman.
Their research spanned from 2013 through 2017, analyzing the disparity between mental health (and substance abuse) and physical health treatment, in terms of out of network (OON) utilization rates, and provider reimbursement rates.
Their report contains a lot of very interesting findings and data. It shows that not only is there a large disparity between mental health and physical health reimbursement and OON use, but it is getting worse. Some key points related to out-of-network utilization are:
The utilization rate for out of network providers was higher than medical and surgical providers for all five years of the study. And between 2015 and 2017, there was an increase in this disparity.
When analyzing just inpatient stays, from 2013 to 2017 they found an 85% increase in disparity.
In that same time period, for outpatient treatment they found a 90% increase in out-of-network use disparity.
In 2017, the out of network use rate for residential treatment centers was above 50%.
Regarding reimbursement rate disparities:
The average in network reimbursement rate for a behavioral health office visit is lower than the average medical/surgical office visit, and this disparity has increased between 2015 and 2017.
As of 2017, primary care reimbursements were almost 24% higher than behavioral health reimbursements. That is an increase of 20.8% in two years.
For office visits, they found that behavioral health providers were reimbursed on average 97.2% of medicare rates (2.8% below medicare rates), while primary care physicians were paid on average 20% ABOVE medicare rates.
When the Mental Health Parity and Addiction Equity Act (MHPAEA) was put into law in 1996, the aim was to have mental health treatment be paid for the same as physical health. Clearly, this is not currently the case, and the disparity is growing. Because in-network reimbursement is so low for mental health providers, many choose to remain out-of-network. What needs to change in order to reverse this trend?