Treatment of mental problems is still a distant dream for many patients in the United States. The country is reeling under mental and behavioral health crises, and those suffering from psychiatric problems are struggling to receive timely and affordable treatment, revealed a study, published recently by consulting firm Milliman.
The findings of the study suggested that out-of-network health services were used four to six times more for behavioral care than medical/surgical care in 2015. The study also found that medical/surgical service providers received 20 percent higher reimbursement rates over behavioral care facilities. The high rate of out-of-network behavioral care represents the treatment costs not covered under insurance. According to the study, patients struggling with mental health or substance abuse issues tend to face higher treatment costs. The costs are so high that even the patients with an insurance cover could not afford them.
The out-of-network providers (both professionals and facilities) delivered 4 percent of medical or surgical care in an inpatient setting, compared to 16.7 percent behavioral care in the same setting in 2015. Moreover, out-of-network providers offered over 5 percent medical/surgical care in an outpatient facility setting, compared to 31.6 percent behavioral care in the same setting.
In the wake of the findings, the researchers at Malliman urged federal regulators, state agencies and employers to carry out random audits of insurers to ensure they abide by the Mental Health Parity and Addiction Equity Act (MHPAEA). The U.S. Congress had passed MHPAEA in 2008 to bring parity between treatment for mental and physical health problems.
The MHPAEA “generally prevents group health plans and health insurers that provide mental health or substance use disorder benefits from imposing less favorable benefit limitations on those benefits than on that of medical/surgical”. Insurers have been for years claiming that they are committed to adhere to the 2008 federal mental health parity law, focused on equalizing mental health coverage and other medical conditions. Many insurers worked to eliminate discrepancies in coverage by taking some steps, including dropping of annual limits to the number of therapy visits. However, disparities continued to bother patients seeking coverage for mental health problems.
Experts also point out the shortage of behavioral health clinicians as a contributing factor toward this disparity. They suggest that health insurers strive hard to rope in mental health providers to offer telemedicine consultation in areas with shortages. However, some behavioral specialists do not participate in contracts, as they are more interested in seeing patients who are ready to pay out of their pocket. This, according to service providers, is the gap that insurers find it difficult to bridge.
According to the data from the 2016 National Health Interview Survey, 3.6 percent adults experience serious psychological distress in the past 30 days. In addition, 65.9 million Americans visited physician offices with mental disorders as the primary diagnosis while 5 million people visited emergency departments for the same problem in 2014.
Amid the growing prevalence of mental health and substance abuse problems, inadequate cover and increased out-of-pocket expenses, the country needs strategic interventions to tackle the crisis. People struggling with mental health problems are as much in need of timely treatment as people with physical problems are. Therefore, it is important to bring parity between both services as stated in the MHPAEA.
Sovereign Health of Florida offers evidence-based residential mental health treatment, including cognitive behavioral therapy (CBT), family therapy and music therapy, among others. For more details about our mental health residential programs, call our 24/7 helpline or chat online with one of our experts.
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