Writer, producer, director
July 21, 2023 at 6:45 am EDT
The Mental Health Equity and Addiction Equity Act passed by Congress in 2008 was supposed to prevent this situation by pushing for equality of mind and body. The law is clearly not working. Congress and the Biden administration must strengthen it. Health insurers should also recognize that it is in the financial interest of improving their coverage of mental health and addiction treatments.
A University of Chicago survey released by the Bowman Family Foundation reflects the experiences of 2,794 patients with commercial insurance, Medicaid or Medicare. As the United States grapples with epidemics of opioid abuse, violence, isolation and suicide, these are questions of life and death for many Americans.
The labyrinthine US health care system is becoming increasingly difficult to navigate. Even when people have insurance, the doctors and other care providers they need to see are often not covered. Patients are forced to choose between debt and despair.
Mental health specialists acknowledge this problem but often say so do not join insurance networks because the plans added unacceptable limits on care, drowned in paperwork to protect medical treatment and reimbursed too little to cover their costs. A a study of insurance claims showed thatas of 2014, “in-network” psychiatrists received reimbursements 13 to 20 percent lower than other doctors providing the same mental health services in the same network. Another study showed that in 11 states, reimbursement rates in 2017 for primary care office visits were more than 50 percent higher than for behavioral office visits.
Eighty percent of patients in employer-sponsored health plans surveyed by University of Chicago researchers said they went out of network for behavioral health care “all the time.” Only 6 percent did so for physical health care.
Psychiatrists, psychologists and other behavioral health care providers who do not charge an insurance fee prices that reflect their education and experience, as well as market demand. This leaves patients with a choice: pay high prices or forgo treatment altogether.
“There’s this big gap between what the market is saying and the relevant price and what insurers are paying,” David Lloyd, chief policy officer of the Kennedy Forum patient advocacy group, told me. “It’s very unfair. You have another layer of access for those who are wealthier who can afford to pay out of pocket, even if it’s a stretch for them.”
Kate Woodsome: ADHD is an illness, not a lifestyle. Don’t punish people for it.
It’s cheaper to stay in network when insurance starts paying, but it’s hard to find a behavioral health specialist when insurance company websites list just a few names or include providers who have left the plan. Forty percent of respondents to the University of Chicago survey said they had to contact four or more in-network providers to get a single appointment.
Patients who are successfully treated often have problems getting reimbursed. Fifty-two percent said they were denied coverage three or more times for behavioral care, according to the University of Chicago study. The figure was 33 per cent for physical care.
The situation is worse in rural areas because few providers practice there. As of 2021, one-third of Americans lived in deprived areas mental health providers. More than half of the US counties not one psychiatrist.
This means that people often turn to general practitioners for support with addiction, depression and other mental health issues. But 87 percent of people in a recent survey said this wasn’t enough: They also needed help from a specialist.
How can these many problems be solved? Through concerted action on the part of government and insurers.
The Biden administration is off to a good start and recognizing the importance of mental health. He sent the hotline 988 regarding suicide and crisis, it is pouring hundreds of millions of dollars training and incentives for clinicians to work in rural and underserved communities, it is investing in scientific research, and funding wellness programs to reduce burnout among frontline health care workers.
Next, the administration needs to strengthen the Mental Health Equity and Addiction Equity Act with clearer guidelines on how to comply. As it stands, the law does not specify exactly what parity looks like for reimbursement rates and provider networks. Insurers take advantage of this ambiguity to protect against all inequities, Lloyd said. Clarity would enable state and federal insurance regulators to enforce the law. Lloyd said the Office of Management and Budget is reviewing the proposed regulations to do this. Separately, the proposed The Parity Enforcement Act If made its way through Congress it would support the law by enabling the Department of Labor to issue fines for violations.
Insurers, for their part, should recognize that they have a powerful incentive to improve their coverage: the close relationship between physical and mental health. Untreated addiction and chronic mental illness can lead to costly physical illnesses or worse. In 2017, people with both behavioral and physical health conditions incurred the An additional $406 billion in health care costs, according to estimates from Milliman, a risk management and health care consulting company. By ensuring that their beneficiaries receive adequate mental health care, insurers can help reduce overall health care costs — saving up to $69 billion a year, according to Milliman.
At the very least, insurers should include more providers who treat behavioral health and pay as much as providers who treat physical health. To attract more mental health and addiction specialists to underserved areas, insurance companies should raise their reimbursement rates and reduce red tape, such as the authorizations to see certain providers.
They would also be smart to compensate providers more for accepting the “collaborative care model,” in which a primary care physician works alongside a mental health care manager and consultant psychiatrist. This integrated care reduces stigma and increases access to mental health and addiction treatments — and promises to save a lot of money.
The US health care system is expensive for families and the country. Morally, improving access is the right thing to do for Americans in pain. Financially, it also makes sense.