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Behavioral health providers shorted by insurers

November 30, 2017

A coalition of mental health and addiction advocacy organizations is calling on federal regulators, employers and state-level agencies to scrutinize insurers’ compliance with parity laws after a study found wide discrepancies between mental health/addiction treatment and physical health coverage.

The report, published by Milliman Inc. and commissioned by the Bowman Family Foundation, found that physical healthcare providers were paid on average about 20% higher rates than behavioral healthcare providers for office visits billed under the same or near-identical codes, with disparities in some states being two or three times greater. Further, while payments to mental health and addiction treatment providers were lower than those to physical health providers, out-of-network visits for inpatient and outpatient behavioral health services dramatically increased over the period covered in the study.

Milliman researchers reviewed insurer claims data from 2013 to 2015, covering 42 million Americans, studying inpatient and outpatient services, as well as primary care and specialist office visits, comparing in-network and out-of-network claims in all 50 states and Washington, D.C.

Among the findings published by Milliman:

  • 31.6% of outpatient facility behavioral healthcare was accessed out-of-network compared to 5.5% of outpatient facility medical/surgical care.
  • 18.7% of behavioral health office visits were accessed out-of-network vs. 3.7% of primary medical/surgical office visits.
  • 16.7% of inpatient facility behavioral healthcare was accessed out-of-network vs. 4.0% of inpatient facility medical/surgical care.

Based on these findings, the mental health and addiction advocacy coalition recommended that federal regulators issue more specific guidance on medical management practices and initiate audits of major insurers, that state-level agencies conduct annual parity compliance market audits of insurers operating in their respective states, and that employers retain independent auditors to review the compliance of insurance plans provided to their employees.

The following organizations comprise the coalition: Parity Implementation Coalition, Mental Health America, National Alliance on Mental Illness, The Kennedy Forum, National Association of Addiction Treatment Providers, American Foundation for Suicide Prevention, The Treatment Advocacy Center, National Association of Psychiatric Health Systems, the Legal Action Center and the American Psychiatric Association.

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