By Kelley Kauffman, MSN, APRN-CNP, PMHNP-BC
This news was brought to my attention via this article from Kaiser Health News, an editorially independent program of the Kaiser Family Foundation. Kaiser Health News is a nonprofit news service that provides in-depth coverage of health care policy and politics.
Eleven years ago, Congress passed the Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008 which generally prevents group health plans and health insurance issuers that provide mental health or substance use disorder benefits from imposing less favorable benefit limitations on those benefits than on medical/surgical benefits. Despite the passage of the MHPAEA and bipartisan consensus that more is needed to confront the opioid epidemic, rising suicide rates, and surging rates of teen depression and anxiety, Americans are finding it harder to access affordable, in-network mental health providers.
In a report released November 20, 2019, Miliman, a risk management and health care consulting company, found that patients are significantly more likely to seek out-of-network providers for mental health and substance abuse treatment than for other conditions. Shockingly, this disparity has only seemed to grow since a similar study was published by Miliman 2 years ago.
So why do insurers continue to reimburse behavioral health providers and services at lower rates? Wouldn’t increasing reimbursement rates incentivize providers to become in-network providers? These appear to be flimsy excuses for why there has been no progress in parity and for why access to care has actually declined.
When employers select a plan for workers, they usually consider whether the network will be adequate, said Michael Thompson, president and CEO of the National Alliance of Healthcare Purchaser Coalitions. But often these are “phantom networks” of providers who no longer accept the insurance or are not taking new patients.
Patients and their families then suffer the consequences. The closest hospital with a psychiatric unit for the boy mentioned in the KHN article was 100miles away. He spent 10 days there before his family learned the hospital was out-of-network. The closest in-network facility was 200 miles away from their home. The family ended up with $110,000 in out-of-pocket expenses for two inpatient visits and residential treatment. They negotiated the amount down with the hospital and a collections agency, then took out loans to pay it off. If mental health services were treated in the same way as medical/surgical services by insurers, this boy would have been able to seek in-network providers closer to home and there would never have been a discussion about how to pay outrageous medical bills. Former U.S. Rep. Patrick Kennedy, who sponsored the federal parity law and now runs the Kennedy Forum, which focuses on implementing the law, said the solution is clear: “The moment [insurers] make payment the same for brain illnesses as for any other illnesses, the sooner we’re going to get to people having the access to the treatment they need.”
Meiram Bendat, a mental health lawyer who has brought several parity lawsuits, said much stronger enforcement by states and the federal government is needed to ensure that patients get the access they are guaranteed under the law. “Without substantial fines against insurers, nothing is going to change because there’s no incentive to change.”
In conclusion, there is a federal law stating healthcare insurers shall not impose less favorable limitations on benefits for mental health or substance use disorders than they would for medical/surgical benefits, but the law has not translated into practice due to lack of regulation and enforcement. Insurers continue to reimburse behavioral health providers and services at lower rates than medical/surgical providers and services. Low reimbursement rates do not incentivize providers to become in-network thus giving the insurers the excuse that the providers choose not to be in-network. There are simple ways to increase the number of in-network behavioral health providers. Insurers must only follow the guidelines of the federal parity law and treat mental health/substance use the same as any other illness.