New Study Highlights Reimbursement Disparities for Mental Health Services in Insurance Networks

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Patients pay more for “out-of-network” psychiatrist services as fewer psychiatrists participate in lower paying “in-network” programs

RESEARCH TRIANGLE PARK, NC – When an individual needs psychiatric care, the first thing to do is to check one’s insurance plan to find a provider. Unfortunately, what many people find are barriers - limited “in network” choice of psychiatrists and other mental health professionals —which translates into decreased access and increased out-of-pocket costs for “out-of-network” services.

 A new study led by Tami Mark, PhD, of RTI International published in the journal Psychiatric Services provides insights on the differential reimbursement of psychiatric services by psychiatrists and other medical providers which may help explain these access barriers. Psychiatrists were found to be reimbursed 13 percent to 20 percent less for providing the same psychiatric services to patients with behavioral health conditions than other types of physicians under “in-network” private insurance.  

The study also revealed that psychiatrists are reimbursed significantly more for patients who they treat out-of-network which may explain why psychiatrists are less likely to participate in insurance networks as compared to other medical doctors. The result is that patients’ choices when seeking care becomes limited. The study documents that patients are more than twice as likely to go “out-of-network” and pay more money out-of-pocket to receive behavioral health treatment from psychiatrists.

Patients count on their health plan to develop networks that offer access to the professionals that they need to treat serious mental illness. Access barriers can have deadly consequences. Suicide is the 2nd leading cause of death among those aged 10 -34, and the fourth leading cause of death among those aged 35 - 54,” states Mark, now senior director, Behavioral Health Financing at RTI International and formerly with Truven Health Analytics. “To remedy this situation, policy makers and payers need to scrutinize whether psychiatrists and other mental health professionals are equitably incentivized to participate in insurance networks.”

The study analyzed 2014 Truven Health Analytics MarketScan Commercial Claims and Encounters Database that captured information on more than 30 million individuals with private insurance. It evaluated what physicians were reimbursed for the most commonly delivered psychiatric services (“evaluation and management” services) to patients with mental health or substance use disorders.  The study was funded by the Substance Abuse and Mental Health Services Administration (SAMHSA).

Mark is an internationally known health economist and expert on behavioral health care financing and delivery. She collaborates with Federal and state agencies to improve their behavioral health treatment systems through research, data analytics, technical assistance, and policy development. Mark has authored more than 100 scholarly peer-reviewed journal articles and numerous government reports on behavioral health financing and delivery. At RTI, she is responsible for leading RTI’s behavioral health financing work.       

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