Out-of-Network Behavioral Health Care on the Rise: A New Study Reveals Patients’ Preference for Specialist Services and the Need for Reimbursement Increases
According to a new study by RTI International, patients were 3.5 times more likely to seek out-of-network behavioral health clinicians in 2021 compared to medical/surgical clinicians. Additionally, for certain behavioral health visits, patients were up to 20 times more likely to choose an out-of-network provider. For example, patients were 8.9 times more likely to see a psychiatrist, 10.6 times more likely to see a psychologist, 6.2 times more likely for acute behavioral inpatient care, and 19.9 times more likely for sub-acute behavioral inpatient care.
The study also found that reimbursement rates for in-network office visits to behavioral clinicians were lower compared to medical/surgical clinicians. This may have created disincentives for providers to participate in-network and contributed to narrower networks of mental health services available to patients. To address this issue, the authors of the study recommend that health plans and states consider increasing reimbursement rates and evaluating reimbursement disparities in order to attract more providers into their networks and improve access to mental health services.
In conclusion, the study highlights the importance of addressing reimbursement discrepancies and expanding network options for patients seeking mental health care in order to improve access and reduce financial burdens on patients seeking behavioral health services.
