OPPA and APA urge action to end disparities in mental health coverage
WASHINGTON, D.C. — People seeking treatment for mental illness and substance use disorders continue to pay more and face more barriers to accessing care than those seeking care for physical illness, according to a report released today from Milliman, Inc., and the disparity has worsened over the past two years.
Patients using commercial PPO health plans – considered “Cadillac plans” because of their “generous” coverage -- are significantly more likely to have to pay out of pocket for mental health care compared to general medical care, according to the report, commissioned by The Bowman Family Foundation. When patients cannot find a physician in the plan’s network, they must go out of network and incur financial responsibility for a large portion of the bill. In 2017, 17% of behavioral office visits were to an out-of-network provider, compared to 3% for primary care providers and 4% for medical/surgical specialists. This disparity is a major financial obstacle to many with mental illness or substance use disorders.
These results are consistent with “secret shopper” studies the American Psychiatric Association has done indicating that provider directories provided by plans for mental health care are inaccurate and it is often not possible to obtain a mental health appointment in a reasonable amount of time because the plan discourages participation by mental health providers through discriminatory reimbursement rates.
In 2017, primary care reimbursements were about 24% higher than behavioral reimbursements. In 11 states primary care reimbursements were 50% higher than behavioral health reimbursements. To make that clear, if a patient sees their primary care provider for treatment of depression, the plan will pay that doctor up to 50% more than it would pay a psychiatrist – a medical doctor with four to five years of additional residency training in mental health care to treat that same patient for depression. This disparity is designed to discourage mental health professionals from participating in plan networks and to ensure that plan participants do not access care.
“The results of this study should set off alarm bells for all of us who care about our nation’s health,” said APA President Bruce Schwartz, M.D. “Discriminating against people with mental illness by restricting their access to care means that more people will suffer and some will die as a result of lack of access to life-saving treatments,” he said. “Given we are in the midst of an opioid epidemic and a public health crisis of rising suicide rates, insurers, states, law enforcement, plantiffs’ attorneys, and the federal government must do better to ensure people who need it can access care.”
“Many states are trying to enforce the Mental Health Parity and Addiction Equity Act, which would preclude these results and APA appreciates their efforts,” said APA CEO and Medical Director Saul Levin, M.D., M.P.A. “But the problem is urgent and needs everyone’s attention. If a plan charges a patient for a product – access to mental health and substance use disorder treatment – and then ensures through its business model that there will be no providers to deliver that treatment – it is an unfair and deceptive trade practice."
The report, Addiction and Mental Health vs. Physical Health: Analyzing disparities in network use and provider reimbursement, is available here.