Many insured Americans go out of network, pay more for behavioral health despite parity laws

Study details high out-of-pocket costs

  • Misti Crane
November 6, 2019
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Health economist Wendy Xu found that out-of-pocket costs remain high for behavioral health despite federal efforts to level the playing field

Americans are using more out-of-network care and paying more out of pocket for behavioral health care than for treatment of other conditions, despite efforts to increase coverage and access to mental health services, according to new research.

Wendy Xu, PhD

The study highlights access barriers to behavioral health providers that lead to high costs for patients, even for those who have private insurance, said lead author Wendy Yi Xu, an assistant professor of health services management and policy at The Ohio State University.

The study appears today (Nov. 6, 2019) in the journal JAMA Network Open.

Xu and her colleagues examined claims from 3.2 million adults with mental health conditions, more than 321,500 with drug use disorders and more than 294,500 with alcohol use disorders. They compared those with claims from people with one of two common chronic conditions – diabetes and congestive heart failure.

Those with behavioral health concerns were more likely to encounter out-of-network providers and to shoulder a greater burden of the cost of their care.

Key findings included:

  • Those with drug-use disorders were almost 13 percentage points more likely to have out-of-network hospitalizations and more than 15 percentage points more likely to experience out-of-network outpatient care than those with congestive heart failure.
  • Enrollees with mental health conditions had cost-sharing payments for out-of-network care that were $341 higher per year on average than enrollees with diabetes.
  • Compared to people with diabetes, those with drug-use disorders paid $1,242 more per year on average for out-of-network care and those with alcohol-use disorders paid $1,138 more.

“Much of this disparity is likely due to the limited availability of behavioral health care providers in insurance plans – the participation rates by these providers are generally low, a problem that is fueled in large part by low reimbursement rates for clinicians, including psychiatrists,” Xu said.

“We saw that people with heart failure and diabetes didn’t go out of network as often and didn’t pay nearly as much for their care, probably because they were able to find care within the network.”

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About The Ohio State University College of Public Health

The Ohio State University College of Public Health is a leader in educating students, creating new knowledge through research, and improving the livelihoods and well-being of people in Ohio and beyond.  The College's divisions include biostatistics, environmental health sciences, epidemiology, health behavior and health promotion, and health services management and policy.   It is ranked 24th among all colleges of public health in the U.S. by U.S. News and World Report, and also includes the top 7-ranked MHA degree program.  The College provides leadership and expertise for Ohio and the world through its Center for Health Outcomes and Policy Evaluation Studies (HOPES) and Center for Public Health Practice (CPHP).