Provider shortage, inaccurate directories hamper mental health coverage parity

Health insurance, pen and stethoscope
Image: Getty/Minerva Studio

Patients seeking mental health services have much more difficulty finding a provider than other medical specialists and often end up paying higher out-of-pocket costs, an indication that mental health coverage caps remain despite parity laws aimed at tightening those disparities, according to a new report. 

One in four respondents in a survey (PDF) by the National Alliance on Mental Illness (NAMI) did not have an in-network mental health therapist or prescriber on their health insurance plan, compared to just one in 10 respondents who reported not having an in-network medical specialist. As a result, beneficiaries were far more likely to have difficulty finding a mental health provider to accept their insurance.

Respondents also were twice as likely to have problems finding an in-network provider for inpatient mental healthcare than for medical care. As a result, survey respondents faced far greater out-of-pocket costs for both outpatient and inpatient mental healthcare, compared to medical care.

“Despite federal law, discrimination still exists in health insurance coverage of mental health conditions when compared to other medical conditions,” NAMI CEO Mary Giliberti said in an announcement.

But the report noted several factors at play, including a critical shortage of mental health providers, inaccurate provider directories and fewer psychiatrists accepting insurance because of low reimbursement and high administrative burden. The organization said health insurers could reduce mental health disparities by keeping up-to-date directories, promoting the integration of mental healthcare and medical care and expanding mental health networks.

The gaps highlighted in the survey should come as no surprise to those following the aftermath of the mental health parity law passed in 2008, along with additional requirements written into the Affordable Care Act. Research has shown several remaining gaps in access to equal mental health benefits and qualified medical providers after some insurers have discovered workarounds to the law, including the use of medical-necessity reviews.

As a result, the Obama administration has made mental health parity enforcement a top priority. Last month, an interagency task force designed to boost implementation of parity laws released a report outlining ways that federal agencies can close the gaps on coverage disparities.