Mental Health Coverage Parity Remains Out of Reach, Survey Says

Out-of-network use of mental health providers for US patients was many times higher than use for medical and surgical treatment—nearly 20 times more for certain behavioral inpatient care—according to a new study that signals mental health benefits parity is still far from a reality.

In-network office visit reimbursement was also 22% higher on average for medical and surgical clinicians than office visits with behavioral clinicians. Reimbursements are the “key levers” that health plans use to encourage in-network participation, the study from nonprofit RTI International said.

“Provider shortages do not explain the disparities in out-of-network utilization and reimbursement,” said the study of more than 22 million people conducted from 2019 to 2021, which was commissioned by the Mental Health Treatment and Research Institute, a subsidiary of nonprofit The Bowman Family Foundation.

The report could fuel calls for health plans and insurers to step up their efforts to meet the requirements of the Mental Health Parity and Addiction Equity Act (MHPAEA), which was enacted in 2008.

The Biden administration issued proposed rules (RIN 1210-AC11) in August 2023, expected to be finalized this summer, that would toughen requirements on employer-sponsored plans. Employer plans are worried that the new requirements would be difficult and costly for them to meet if they’re finalized.

MHPAEA prohibits health plans that provide mental health coverage from imposing more restrictive mental health benefits than are imposed for access to comparable medical and surgical benefits.

The RTI International study found that patients went out-of-network 3.5 times more often to see a behavioral health clinician than a medical or surgical provider, even for telehealth visits, which have been used more frequently for behavioral health since the Covid-19 pandemic. The high out-of-network use created a “significantly greater financial burden for behavioral health patients,” the report said.

That number rose to 8.9 times more out-of-network visits to see a psychiatrist and 10.6 more to see a psychologist.

Physician assistants were reimbursed for office visits an average of 19% higher than psychiatrists and 23% higher than psychologists, the study said.

Spending on benefits that address mental health and substance abuse rose by 53% from March 2020 to August 2022 among people with employer-provided insurance, according to a separate study by the RAND Corp. and Castlight Health.

Mental health service use in August 2022 was nearly 39% higher than before the pandemic, the RTI study said.

“This research demonstrates the profound need for employers and purchasers to demand more of their health insurance carriers to ensure they are providing truly equitable access to behavioral health care in compliance with parity requirements,” Shawn Gremminger, president and CEO of the National Alliance of Healthcare Purchaser Coalitions, said in a statement.