Why's It Still So Hard To Access Mental Health Care?

By Kelly Burch 09/08/17

A new study examined Affordable Care Act insurance plan networks to find out why.

a patient lying in a sofa during a visit with a psychologist.

Despite legislative efforts to equalize insurance coverage for mental health and substance use issues, a recent study found that it's still more difficult to get insurance coverage for mental health care than it is for physical health. 

The study, conducted by researchers at the University of Pennsylvania and published in the journal Health Affairs, found that Affordable Care Act insurance plan networks include 24% of primary care providers in a given area, on average. However, the plans only include 11% of behavioral health providers, according to The Philadelphia Inquirer. 

This creates a so-called “narrow network,” meaning it offers a limited pool of providers. As a result, insured people may be unable to find a provider who is taking patients because there are relatively few providers to choose from. 

“There is increasing concern about the extent to which narrow-network plans, generally defined as those including fewer than 25% of providers in a given health insurance market, affect consumers’ choice of and access to specialty providers—particularly in mental health care,” study authors wrote. 

The study also found that mental health providers were less likely than doctors specializing in physical health to participate in an insurance network. Only 42% of psychiatrists and 19% of non-physician mental health care providers worked within any given insurance network looked at in the study. 

“These findings raise important questions about provider-side barriers to meeting the goal of mental health parity regulations,” the study authors wrote. Legally, insurance companies are required to cover mental health services just as they would physical or surgical services. 

The study authors said that a possible solution could involve more regulation and also encouraging more mental health providers to participate in insurance networks. “Concerted efforts to increase network participation by mental health care providers, along with greater regulatory attention to network size and composition, could improve consumer choice and complement efforts to achieve mental health parity,” they wrote. 

Lead study author Jane M. Zhu told the Inquirer that federal legislation requiring equal coverage for mental health and addiction treatment has “actually done quite a bit to promote parity.” However, she said that this study shows the actual market effects of the legislation, which may not be functioning as it was intended to. “What we are looking at are the downstream effects of that,” she said. 

Zhu added that the study demonstrates the importance of checking if certain providers are in-network before they purchase an insurance plan. 

“It is really important for consumers to check the provider directory before purchasing plans,” she said, before acknowledging that it's not easy in an often confusing insurance marketplace. 

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Kelly Burch writes about addiction and mental health issues, particularly as they affect families. Follow her on TwitterFacebook, and LinkedIn.