The Research Triangle Institute just updated their analysis of the state of parity 16 years after providing equal benefits for mental health care and medical care became the law in the United States. In short, parity is a LONG way away still. For the same services, psychiatric physicians are paid substantially less than any other physicians. In fact, psychiatric physicians are paid 20% less than physicians assistants providing general medical care.
Because reimbursement is so low for in-network care, Gateway Psychiatric is unable to accept insurance payment.
Not surprisingly, fewer people are able to get “in-network” care in psychiatry than in any other area of medicine.
The shock, honestly, is that insurance companies have been able to flout the law so obviously for such a long time.
This is the from the Executive Summary –
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.
Reference
Mark, T. L., & Parish, W. J. (2024). BEHAVIORAL HEALTH PARITY – PERVASIVE DISPARITIES IN ACCESS TO IN-NETWORK CARE CONTINUE. RTI International.
Related Content
