MoodSurfing celebrated the passage of the Mental Health Parity and Addictions Equity Act (MHPAEA) of 2008, when it was first passed. We again celebrated in 2013 when the Obama administration issued guidelines for the implementation of the legislation, including parity in payments made to mental and physical health practitioners; parity in limitations in coverage (for example the number of days of treatment that may be covered); and parity of in-network access for mental health conditions compared to physical conditions.
Now, a report by the non-partisan Research Triangle Institute shows that severe disparities in access to mental health care are found across almost all states, and many major insurers continue to find and exploit loopholes in the legislation to deny coverage to patients needing mental health treatment. The overview of their findings are listed below. For full data and definitions of terms, see the link to the published report under “References” below.
Findings
(1) Out-of-network use was many times higher for behavioral health treatment than medical/surgical treatment, which created a significantly greater financial burden for behavioral health patients. This was true even for telebehavioral visits as compared to telemedicine visits.
(2) Office visit in-network reimbursement levels were much lower for behavioral health providers than for medical/surgical providers creating disincentives for behavioral health providers to participate in-network. For example, psychiatrists and psychologists had lower reimbursements than physician assistants.
(3) The disparities in out-of-network use have remained large over the last 9 years for office visits, where most behavioral health care is delivered.
(4) Provider shortages do not explain the disparities in out-of-network utilization and reimbursement.
(5) These results demonstrate the need for more robust parity enforcement.
We fully endorse the recommendations coming out from this report, including that mental health care networks be expanded and practitioners be equitably reimbursed by insurers in order to reduce patients’ need to seek out-of-network care for mental health conditions. We also call on state and federal regulators across the country to study existing disparities in access to health care and identify and remedy parity violations in health care plans.
Denial of coverage in violation of mental health care parity regulations is bad faith conduct by an insurance company. Since the policy was sold on the basis that it was in compliance with all Federal and state guidelines, denial in violation of these regulations is a failure to do business in good faith. Complaints of bad faith are taken very seriously by regulators, and by the insurance companies themselves. If you believe you are being unfairly denied coverage by your insurance company in violation of mental health care parity regulations, we recommend Nolo.com, a company that specializes in making legal advice more easily available to everyone:
https://www.nolo.com/legal-encyclopedia/insurers-bad-faith-injury-cases.htm
A legal practice that specializes in disability, mental health care and other issues in the San Francisco area is: DL Law Group. You can contact them through their website: https://www.dllawgroup.com/
References:
Mark, T. L., & Parish, W. J. (2024). Behavioral health parity – Pervasive disparities in access to in-network care continue. RTI International.