Low reimbursement rates from private payers to mental health providers may curb patient access

Reimbursement rates from commercial insurers to mental healthcare providers may hinder patient access to such care, according to a new study. 

Researchers from the Congressional Budget Office analyzed data from the Health Care Cost Institute—which includes claims for 39 million Aetna, Humana and UnitedHealthcare members—and found that commercial plans paid in-network providers 13% to 14% less than fee-for-service Medicare for psychotherapy or evaluation and management services. 

However, the payouts to out-of-network providers were significantly higher, the study found. Private payers paid 43% more to these doctors for E&M care, for example, and 53% more for out-of-network psychotherapy. 

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These gaps pose a problem, the researchers said, amid calls for greater parity in access to mental health services: Providers aren’t going to sign on with health plans when they know their reimbursement could plummet. 

The lower reimbursements could also prevent clinicals from entering mental or behavioral healthcare at all, further hindering access goals, they said. 

“Parity’s promise may remain unfulfilled if patients cannot access in-network providers,” the authors wrote. “The success of parity may ultimately hinge on whether payment rates to mental health providers increase over time, higher payment rates expand supply or insurers can expand access without raising premiums.” 

Medicare Advantage plans, the researchers found, paid out rates on par with traditional Medicare. That said, Medicare rates may also be too low to truly boost access—for example, Medicare will reimburse a 45-minute therapy session for $79.76, while it will pay $106.28 for an intermediate-intensity office visit. 

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Payment rates are so low across the board the mental health providers have historically been unwilling to accept any insurance coverage, the study noted. 

Demand for mental and behavioral healthcare is high. A recent survey of 5,000 people found that nearly 6 in 10 had sought such services for themselves or a loved one, but the costs remain the biggest barrier. 

About 20% of those surveyed said the high cost of behavioral health led them to choose between a mental health service or a physical health service.