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Insurance Coverage for Mental Health Concerns Isn't Getting Better

Insurance Coverage Parity for Mental Health Concerns Is Getting Worse

As a testament to the ineffectiveness of laws when not rigorously enforced (hello, speed limit, I’m looking at you!), the lack of enforcement on mental health parity has been devastating. Mental health parity means that insurance companies are required, by law, to offer the same coverage and benefits for mental disorders as they do for physical conditions.

When an American seeks treatment for a mental health or substance abuse problem, chances are they are going to face some pretty steep hurdles. And those hurdles are only getting worse before they get better, according to a new study examining insurance claim data from 2016-2017.

The new study was funded by the Bowman Family Foundation and published by Milliman. It looked at the insurance claims data — the paperwork providers file with an insurance company in order to get paid.

The research shares some disappointing data, including this bombshell: “In 2017, out-of-network use for behavioral health was 520% more likely than for medical/surgical, up from 280% in 2013.”

What that means is that nearly twice as many Americans are turning to mental health professionals outside of their insurance’s network of covered providers in 2017 than in 2013. Why is that? Likely because insurance companies notoriously compile and maintain out-of-date, ghost provider databases of mental health professionals that supposedly are accepting new clients — but aren’t.

These ghost directories (or ghost networks) are so-called because many — and in some cases, most — of the professionals listed for many behavioral healthcare specialties (such as psychiatry) don’t actually take new patients. That means it is virtually impossible to actually get an appointment with a professional covered by your insurance company.

Customers of the insurance company are forced to call around, going down the entire list of providers listed in the company’s database, trying to find a professional who take them. In the case of a psychiatrist, for instance, if a person does find one willing to take on new patients, the wait time for the first appointment is measured in months, instead of days.

This is not parity. Compared to getting an appointment with an internist or primary care physician, there exists a large and growing disparity between coverage between mental health and physical concerns.

Exasperated by waiting, or finding no professionals actually open to new clients, customers are going “out of network” to find a professional who will take them in a reasonable amount of time. Even if it means paying more for their care and treatment.

Most people don’t experience anything quite like this when needing to consult a medical professional for a traditional physical disease.

Substance Abuse Treatment Is Even Worse

Not surprising, substance abuse treatment was even worse. Patients seeking treatment for opioid addiction or some other substance abuse problem were 1000% more likely to use an out-of-network provider when compared to medical/surgical care in 2017.

This statistic was also double the finding from 2013, when it was still an astonishing 470%.

Worse yet, the reimbursement rate disparities for these kinds of issues increased every year too, when compared against traditional medical/surgical reimbursement rates.

Children’s Mental Health Care Is Worse Than Adults

According to the new report, in 2017, if your child needed to see a behavioral healthcare provider — such as a child psychologist — Americans were 10.1 times more likely to see a professional out-of-network than if they were seeing a primary care provider. This finding was twice the disparity the study found for adults.

This, again, is due to the lack of child mental health specialists being unavailable in an insurance company’s network.

Insurance Companies Pay More to Treat & Cover Physical Diseases Over Mental Disorders

The study also found a consistent disparity between what insurance companies pay professionals based upon the type of office visit they make. The study discovered that primary care reimbursements were nearly 24 percent higher when compared to reimbursing for behavioral health care visits.

And in some cases — 11 states in all — that difference grows to a whopping 50 percent greater reimbursement rate. It’s no wonder it’s getting harder and harder to convince medical students to go into psychiatry or other behavioral healthcare professions. Despite it being illegal to do so, insurance companies still treat both professionals and their patients seeking mental health treatment as second-class citizens. Every action they take demonstrates this attitude toward mental health care.

What Can Be Done About It?

While the federal government passed laws to prevent this sort of disparity from occurring — in both 1996 and again in 2008 — it’s clear the laws aren’t working in the way they were intended. Insurance companies continue to discriminate against people with mental disorders and needing mental health treatment. Instead of creating equalness between physical and mental conditions, it’s clear from this study’s data that the differences are actually increasing instead of decreasing.

Congress can readily provide the resources needed to enforce these laws and call out insurance companies who are continuing to provide ghost networks of behavioral healthcare providers, as well as those who continue to put limits on how mental health care is delivered compared to the delivery of primary care. More should be done to rectify the difference in reimbursement rates, to acknowledge the importance and difficulty in treating mental health conditions.

Read the full report: Addiction and mental health vs. physical health: Widening disparities in network use and provider reimbursement (PDF)

Insurance Coverage Parity for Mental Health Concerns Is Getting Worse


John M. Grohol, Psy.D.

Dr. John Grohol is the founder and Editor-in-Chief of Psych Central. He is a psychologist, author, researcher, and expert in mental health online, and has been writing about online behavior, mental health and psychology issues since 1995. Dr. Grohol has a Master's degree and doctorate in clinical psychology from Nova Southeastern University. Dr. Grohol sits on the editorial board of the journal Computers in Human Behavior and is a founding board member of the Society for Participatory Medicine. You can learn more about Dr. John Grohol here.


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APA Reference
Grohol, J. (2019). Insurance Coverage Parity for Mental Health Concerns Is Getting Worse. Psych Central. Retrieved on December 15, 2019, from https://psychcentral.com/blog/insurance-coverage-parity-for-mental-health-concerns-is-getting-worse/
Scientifically Reviewed
Last updated: 3 Dec 2019 (Originally: 3 Dec 2019)
Last reviewed: By a member of our scientific advisory board on 3 Dec 2019
Published on Psych Central.com. All rights reserved.