Patients 4 times more likely to see out-of-network behavioral providers than medical providers

Patients are more likely to seek care from out-of-network behavioral health providers than from out-of-network medical or surgical providers, a report from the Research Triangle Institute found. 

The research institute concluded that inadequate payments from insurers, not provider shortages, are the main cause of a lack of in-network options for patients. 

The average reimbursement for medical and surgical clinician office visits was 21.7% higher than for all behavioral health clinicians in 2021, the report found. 

"Health plans could create robust networks for behavioral health providers in each region by increasing payments to those behavioral health providers who are already available (as shown by the existence of out-of-network claims) but who are not in-network," the study's authors wrote. 

In an April 17 news release, Arthur Evans Jr., PhD, CEO of the American Psychological Association, said the findings of the report "while not surprising, are gravely disappointing." 

"The federal parity law, the Mental Health Parity and Addiction Equity Act, passed in 2008 and it has still not achieved its goal of equitable access to care for mental health patients," Dr. Evans said. "The report also highlights the importance of fully enforcing that law. The fact that so many patients are forced to go out of network to receive mental health and substance use care is unacceptable." 

Patients were 3.5 times more likely to visit an out-of-network behavioral provider than for medical or surgical office visits in 2021, the report found. These disparities were higher by provider type. Patients went out-of-network 8.9 times more often for psychiatrist office visits and 10.6 times more often for psychologist office visits than for medical or surgical specialist visits. 

The Research Triangle Institute recommended payers work to create larger behavioral health networks, increasing reimbursement rates if necessary. The institute also recommended federal and state agencies toughen their enforcement of mental health parity laws. 

Read the full report here. 

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