Analysis Uncovers Significant Inequalities Between Mental And Physical Health: Lower Payments To Providers And Wide Disparities In Access To Benefits

WASHINGTON, Nov. 30, 2017 /PRNewswire-USNewswire/ — Physical healthcare providers are receiving significantly higher payments from insurers than addiction and mental health providers for the same types of services, finds a groundbreaking, independent report published today by Milliman, Inc. and released by a coalition of America’s leading mental health and addiction advocacy organizations. In the Milliman report, commissioned by the Bowman Family Foundation, researchers found that along with payment disparities, which occur in 46 out of 50 states, “out-of-network” use of addiction and mental health treatment providers by consumers is extremely high when compared to physical health care providers.
Milliman researchers used three years of insurer claims data from 2013 to 2015 covering 42 million Americans, and looked at inpatient and outpatient services, primary care office visits, and specialist office visits, comparing in-network and out-of-network claims in all 50 states and D.C. When taken together, the analysis paints a stark picture of restricted access to affordable and much-needed addiction and mental health care in an era of escalating suicide rates and opioid overdose deaths. Further, these disparities point to potential violations of federal and state parity laws, which require insurance companies to treat diseases of the brain, such as clinical depression and opioid addiction, the same way they treat illnesses of the body, such as cancer and heart disease.

“Clearly, these access restrictions fan the flames of the opioid crisis and suicide deaths, two of the most urgent public health challenges we face as a nation,” said former Congressman Patrick J. Kennedy (D-R.I.), member of the President’s Commission on Combating Drug Addiction and the Opioid Crisis, author of the Mental Health Parity and Addiction Equity Act, and founder of The Kennedy Forum, whose ParityTrack initiative includes state-specific data from Milliman, as well as a registry for complaints about insurance denials. “If nearly 300 people dying each day from overdoses and suicides isn’t sufficient to motivate insurers to take immediate action to improve access to the full range of in-network benefits, we have a real problem – and it’s time to start holding them publicly accountable.”

One of the most dramatic disparities outlined in the report is the low reimbursements paid to behavioral health providers when compared to physical health providers – a factor likely influencing network access and overall practitioner in-network availability. The researchers discovered that physical healthcare providers were paid, on average, about 20% higher rates than behavioral health providers for the very same office visits billed under identical or similar codes. In many states, the disparities in payment rates were 2-3 times greater.