Parity And The Use Of Out-Of-Network Mental Health Benefits In The FEHB Program

Regier, Darrel A.; Bufka, Lynn F.; Whitaker, Tracy; Duffy, Farifteh F.; Narrow, William E.; Rae, Donald S.; Reed, Geoffrey M.; Rehman, Omar F.; Rubio‐Stipec, Maritza; Weismiller, Toby; Wilk, Joshua E.; West, Joyce C.

doi:10.1377/hlthaff.27.1.w70

Cited by 12 publications

(8 citation statements)

References 9 publications

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“…15 The authors found that two-thirds of specialty mental health providers in the Washington, D.C., area did not participate in federal employee health plan networks, which suggests that extending parity to out-of-network mental health or substance use disorder services could improve enrollees’ ability to access needed care.…”

Section: Previous Research On Substance Use Disorder Paritymentioning

confidence: 99%

Federal Parity Law Associated With Increased Probability Of Using Out-Of-Network Substance Use Disorder Treatment Services

McGinty

Busch²,

Stuart

et al. 2015

Health Affairs

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The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 requires commercial insurers providing group coverage for substance use disorder services to offer benefits for those services at a level equal to those for medical or surgical benefits. Unlike previous parity policies instituted for federal employees and in individual states, the law extends parity to out-of-network services. We conducted an interrupted time-series analysis using insurance claims from large self-insured employers to evaluate whether federal parity was associated with changes in out-of-network treatment for 525,620 users of substance use disorder services. Federal parity was associated with an increased probability of using out-of-network services, an increased average number of out-of-network outpatient visits, and increased average total spending on out-of-network services among users of those services. Our findings were broadly consistent with the contention of federal parity proponents that extending parity to out-of-network services would broaden access to substance use disorder care obtained outside of plan networks.

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Section: Previous Research On Substance Use Disorder Paritymentioning

confidence: 99%

Federal Parity Law Associated With Increased Probability Of Using Out-Of-Network Substance Use Disorder Treatment Services

McGinty

Busch²,

Stuart

et al. 2015

Health Affairs

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“…3 Mental health providers cite low reimbursement levels and unacceptable limits on care receipt as reasons for lack of network participation. 3-5 From a patient perspective, continuity of care may be more valued for mental health treatment compared to general medical treatments, particularly for patients being treated with psychotherapy. Patients may be willing to pay more out-of-pocket to complete treatment with a trusted provider who may no longer have in-network status.…”

mentioning

confidence: 99%

“…Another study examined rates of out-of-network mental health care use in the Washington, DC, area after implementation of the Federal Employee Health Benefits (FEHB) parity initiative and found that only 43% of the FEHB-insured caseload was treated by an in-network provider during the sampled visit. 5 Given the lack of recent information on national rates of out-of-network mental health care use, we sought to (1) estimate the proportion of privately insured adults using an out-of-network mental health provider in the past 12 months; (2) compare rates of out-of-network mental health provider use with general medical out-of-network use; and (3) determine reasons for out-of-network mental health care use. We specifically examine whether individuals reported reasons related to network size and composition or provider quality.…”

mentioning

confidence: 99%

Out-of-Network Provider Use More Likely in Mental Health than General Health Care Among Privately Insured

2013

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Objective Previous research has shown relatively high use of out-of-network mental health providers, although direct comparisons with rates among general health providers are not available. We aimed to (1) estimate the proportion of privately insured adults using an out-of-network mental health provider in the past 12 months; (2) compare rates of out-of-network mental health provider use with out-of-network general medical use; (3) determine reasons for out-of-network mental health care use. Methods A nationally representative sample of privately insured US adults was surveyed using the internet in February 2011. Screener questions identified if the participant had used either a general medical physician or a mental health professional within the past 12 months. Respondents using either type of out-of-network provider completed a 10-minute survey on details of their out-of-network care experiences. Results Eighteen percent of individuals who used a mental health provider reported at least 1 contact with an out-of-network mental health provider, compared to 6.8% who used a general health provider (P < 0.01). The most common reasons for choosing an out-of-network mental health provider were the physician was recommended (26.1%), continuity with a previously known provider (23.7%), and the perceived skill of the provider (19.3%). Conclusions Out-of-network provider use is more likely in mental health care than general health care. Most respondents chose an out-of-network mental health provider based on perceived provider quality or continuing care with a previously known provider rather than issues related to the availability of an in-network provider, convenient location, or appointment wait time.

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“…For example, one study found that 35% of psychiatrists do not participate in managed care networks (O'Malley and Reschovsky 2009). Regier et al (2008) found that among Federal Employee Health Benefit Plan members in Washington, D.C., less than 50% of mental health patients were receiving care from an in-network provider. However, it is not clear if low mental health provider participation rates correlate with difficulty accessing an in-network provider.…”

Section: Network Inadequacymentioning

confidence: 99%

The Out-of-Network Benefit: Problems and Policy Solutions

Kyanko¹,

Busch²

2012

INQUIRY

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Health insurance plans that include coverage for out-of-network providers are common and have the potential to reduce health care costs and even improve quality. Yet, consumers may be exposed to significant unexpected and unreasonable out-of-pocket costs due to lack of accurate information on network participation, nontransparent out-of-pocket costs, inadequate provider networks, involuntary use of out-of-network emergency care, and use of out-of-network providers at in-network hospitals. Although the Affordable Care Act and some states provide some consumer protections, these may not be adequate.

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Parity And The Use Of Out-Of-Network Mental Health Benefits In The FEHB Program

Cited by 12 publications

References 9 publications

Federal Parity Law Associated With Increased Probability Of Using Out-Of-Network Substance Use Disorder Treatment Services

Federal Parity Law Associated With Increased Probability Of Using Out-Of-Network Substance Use Disorder Treatment Services

Out-of-Network Provider Use More Likely in Mental Health than General Health Care Among Privately Insured

The Out-of-Network Benefit: Problems and Policy Solutions

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