The National Alliance on Mental Illness (NAMI) published a report titled “Out-of-Network, Out-of-Pocket, Out-of-Options: The Unfulfilled Promise of Parity.” This report refutes the promises of 2008’s Mental Health Parity and Addiction Equity Act (MHPAE) that, purportedly, made it law that benefits for mental health should be equal to benefits for physical illnesses, including surgeries. According to NAMI, “… [The report] …echoes the same truth about the status of mental health parity: we’re not there yet.”
Survey says: Over 3,000 polled regarding mental health benefits
In the winter of 2015, NAMI conducted an online survey that included responses from more than 3,000 participants. In order to participate in the survey, respondents were required to carry private insurance or government coverage, such as Medicaid.
The majority of respondents had incomes below the national average or about $25,000 per year.
Either you’re IN or you’re out: Network coverage falls short
The unwavering opinion discovered in the survey results is that out-of-network coverage is anything but. For example, with respect to primary care physicians, individuals with in-network coverage responded overwhelmingly that they had access to a doctor. However, out-of-network respondents had only a three percent opportunity to be seen by their primary care physician. Results showed that 73 percent of individuals in network had access to a mental health therapist compared to 27 percent of out-of-network respondents.
The report quotes an anonymous respondent who stated, “The majority of mental health professionals in my area do not participate in any insurance plans. My insurance plan has an $8,000 deductible for out-of-network benefits.” The respondent added that, per the Usual and Customary Reasonable rate (UCR), insurance reimbursed $60 for a $215 psychiatrist visit.
Inpatient mental healthcare
Most of the respondents admitted to incurring high expenses and going out-of-network for psychiatric care. According to the survey:
- Up to 87 percent of individuals requiring psychiatric care received treatment from an in-network psychiatric facility, whereas 92 percent who required non-mental health hospitalization were able to receive in-network care. On a corollary note, people requiring psychiatric care were twice as likely to experience difficulty locating a facility that would accept insurance compared to individuals seeking non-psychiatric medical attention
- With respect to residential mental health treatment, one in three survey participants did not receive treatment in an in-network residential mental health facility and one in four had trouble locating a facility that accepted their insurance
Comparisons between outpatient and inpatient out-of-pocket costs (OOPC) reveal that for every quantifiable category – primary care provider, medical specialists, mental health prescriber, mental health therapist, medical hospital, mental health hospital and mental health residential – the discrepancy between in-network versus out-of-network care is substantial. For example, OOPC for mental health services for in-network patients range from $1 to $199, depending on the service. OOPC for an individual who is out-of-network begin at $200.
It is important to understand that an individual who is in-network may have to travel a great distance to find an in-network provider. In rural and underserved areas, the local urgent care or walk-in clinic most likely will not accept an individual’s insurance. The following demonstrates the quandary many insurance subscribers experience. The report quotes another anonymous respondent: “I have a psychiatrist, insurance will only reimburse him $75 for an hour of services. He is out-of-network at $225 an hour. My current insurance has no deductible limit on out-of-network services.”
Earlier in 2016, many of the major insurers announced they will be withdrawing from the Affordable Health Care Act markets, citing rising costs as the reason. This translates to even less access to mental health care providers for individuals in rural and underserved areas.
Sovereign Health of California provides the highest quality treatment for individuals with mental health and substance abuse disorders. We create individual treatment plans based on each patient’s needs. We employ the latest evidence-based treatments to ensure each patient receives the highest standard of care possible.
About the author:
Darren Fraser is a content writer for Sovereign Health. He worked two-and-a-half years as a reporter and researcher for The Yomiuri Shimbun until they realized he did not read, speak or write Japanese and fired him. Undeterred, he channels his love of research into unearthing stories that provide hope to those dealing with addiction and mental illness. Darren loves the Montreal Canadiens hockey club and horror films and would prefer to enjoy these from the comfort of his family’s farm in Quebec. For more information about this media, contact the author at email@example.com.