Monday, May 28, 2018

Mental Health Care -- Far from Equal (Part 2)

4 Helpful Actions Employers Can Take

It's been 10 years since the Mental Health Parity and Addiction Equity Act was passed, so it seems like a good time to pause and ask ourselves if access to care is now equal. M
ost insurers have dropped visit limits and separate deductibles and co-insurance for mental health care yet patients are still struggling to get access to treatment. A report from Milliman concluded:
The difference between medical/surgical and
behavioral health use out-of-network by state.
 Source: Milliman - 2017
  • In 2015, behavioral care was four to six times more likely to be provided out-of-network than medical or surgical care.
  • Insurers pay primary care providers 20 percent more for the same types of care as they pay addiction and mental health care specialists, including psychiatrists.
  • State statistics vary widely. In New Jersey, 45 percent of office visits for behavioral health care were out-of-network. In Washington D.C., the figure was 63 percent.6
In part, because reimbursement rates are low, mental health practitioners choose not to participate with insurance networks. Participation also means dealing with all the paperwork and bureaucracy involved in filing insurance claims. Many mental health care providers are solo practitioners and they don't have the administrative support they need to deal with insurance coverage.


Patients with mental health and substance abuse problems are often forced to go out-of-network to find care. Out-of-network care is subject to deductibles and significant co-insurance if there is any out-of-network benefit available at all. The need for mental health care seems even greater than it did 10 years ago:
  • One in five American adults has a mental illness.
  • One in 10 full-time employees has an addiction, and we are in the midst of an opioid crisis.
  • Mental illnesses are the leading cause of disability worldwide.
  • About 90% of people who die by suicide—the 10th leading cause of death in the U.S.—have an underlying mental illness.
What can employers do to ensure their employees have access to mental health care? 
  1. Push your insurance network to add mental health providers. 
  2. Promote a collaborative care model that incentivizes primary care providers to screen for mental health problems. 
  3. Support primary care doctors and patients with behavioral health navigators that help patients get access to appropriate, cost-effective care. 
  4. Maintain an insurance option with out-of-network coverage for your employees until adequate care is available in-network.
I have a feeling this could be a long series of posts. You can find the first one that includes an interesting take on the issues from Maggie McGary here. If you want to learn more, I recommend starting with these resources.