Data shows that insurance companies have significant in-network mental healthcare gaps

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Data shows that insurance companies have significant in-network mental healthcare gaps

Close up of a person handing a credit card to a pay at a medical office.

Many Americans lack access to essential healthcare, with in-network mental healthcare benefits being among the most difficult kinds of care to access. Whereas roughly one in six primary care providers (58.4%) participate in any insurance network, only about one in four psychiatrists (42.7%) and less than one in two nonphysician mental healthcare providers (19.3%) participate in any network, according to a 2017 study. 

Various factors contribute to the lack of in-network mental healthcare coverage, including provider shortages and geographic barriers, but insurance limitations are a key driver of coverage gaps. A growing body of research shows that lower insurance reimbursement rates for mental healthcare fuel access issues.

In 2008, lawmakers passed the Mental Health Parity and Addictions Equity Act (MHPAEA), which aimed to prevent insurers from discriminating against mental health and substance use disorder treatments. In theory, it ensures access to mental healthcare coverage. In practice, though, many insurance companies have fallen short of MHPAEA provisions, including reimbursement rate settings, leading Congress to pass a 2020 act requiring insurance companies to prove their compliance with MHPAEA’s care provisions. Still, coverage gaps persist: a recent study analyzing data from commercial insurance databases between 2019 and 2021 found that people cannot access in-network behavioral health treatment as easily as medical or surgical treatment. 

To assess how insurance coverage gaps impact mental healthcare access, Charlie Health looked at the numbers, including data on how many in-network mental healthcare providers are actually available for appointments and which states have the best and worst mental healthcare coverage. 

Patients are up to 10 times more likely to seek out-of-network mental healthcare than medical or surgical care

According to a 2024 report from the Research Triangle Institute, patients are more likely to seek out-of-network behavioral health benefits than physical care benefits. The study, which analyzed commercial insurance data from 2019 to 2021, found that people are up to 10.6 times more likely to seek out-of-network care from psychologists. It also concluded that patients are 3.5 times more likely to seek out-of-network care for behavioral health clinicians and 8.9 times more likely for psychiatry services. 

Insurance companies reimburse mental health providers 22% less on average than physical health providers

The same 2024 report found that reimbursement rates for in-network office visits with behavioral health specialists were, on average, 22% lower than for medical or surgical clinicians. Also, psychologists and psychiatrists were reimbursed 23% and 19% less, respectively, than physician assistants. A 2017 study published in “Psychiatric Services” found similar payment disparities between mental and physical health providers. The study concluded that psychiatrists were paid up to 20% less than nonpsychiatrist medical doctors for the same in-network evaluation and management services, depending on the severity of the diagnosis. 

Put another way, for every $1 that insurance companies reimbursed primary care physicians in preferred provider organizations (PPOs) in 2017, they reimbursed behavioral health professionals only 76.2 cents, according to another study. 

Out-of-network reimbursement rates may incentivize providers to avoid working with insurance

Despite low in-network reimbursement rates, some mental health professionals earn more for out-of-network services than non-mental health professionals. The 2017 “Psychiatric Services” study found that for out-of-network services, psychiatrists received 28% more for patients with low to moderate problems and 6% more for those with moderate to high severity issues compared to nonpsychiatrist doctors. Low payments to psychiatrists within insurance networks can deter them from joining these networks, while higher payments for out-of-network services may encourage them to avoid contracting with insurers altogether, according to the study.

Up to three-quarters of in-network providers may not be available for appointments in some instances

Even if consumers are proactive and seek in-network coverage for their behavioral health needs, they may encounter obstacles. A 2015 study found that researchers could not schedule appointments with nearly three-fourths of the psychiatrists listed as in-network providers with Blue Cross Blue Shield in three major cities. The issues included incorrect contact information and providers who either did not accept insurance or were not accepting new patients. There are similar inaccuracies in nearly half of the entries reviewed in Medicare Advantage directories, one study found.

In-network behavioral healthcare access varies based on state

In-network behavioral healthcare access is not equal across the United States. Every year, Mental Health America (MHA) compiles data on access to insurance, access to treatment, quality and cost of insurance, access to special education, and workforce availability to determine an overall national Access Ranking of all 50 states. 

A high Access Ranking (1-13) indicates that a state provides relatively more access to insurance and mental health treatment. According to the most recent MHA data, states that fall into this category include Vermont, Massachusetts, Maine, Wisconsin, and Minnesota. By contrast, a low range (40-50) indicates that a state provides relatively less access to insurance and mental health treatment. States in the low range include Texas, Alabama, Florida, Georgia, and Mississippi. See the full Access Ranking here.

How to access in-network mental healthcare

Accessing in-network mental healthcare services is, first and foremost, a systemic issue. Above all, lawmakers need to require insurance companies to provide equitable reimbursement for mental healthcare services. Below are some other steps that can be taken if you are trying to access in-network mental healthcare. 

Check your insurance plan

Review your insurance policy to understand what mental health services are covered and which providers are in-network. This information is often available on your insurer’s website, or you can call the customer service line listed on the back of your insurance card. 

Find providers

Use your insurance company’s online directory or contact providers directly to find in-network mental health providers, including therapists and psychiatrists. Remember to confirm that the provider you choose is still in-network with your insurance, as affiliations can change. You can confirm this by contacting the provider’s office directly or your insurance company.

Schedule an appointment

Contact your chosen provider and schedule an appointment. Make sure you provide your insurance details so they can verify coverage and benefits.

This story was produced by Charlie Health and reviewed and distributed by Stacker Media.

 

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