Comparedto people with diabetes, those with drug-use disorders paid $1,242more per year on average for out-of-network. (Image:Shutterstock)

People who need behavioral health treatment often need to go outof their insurance plan's network to receive care, and as such,they typically shell out more in out-of-pocket costs than thosewith other types of ailments, according to a study posted on JAMA Network Open.

The researchers, led by Wendy Yi Xu, an assistant professor ofhealth services management and policy at The Ohio State University,examined commercial insurance claims from 3.2 million adults withmental health conditions, more than 321,500 with drug use disordersand more than 294,500 with alcohol use disorders. They comparedthose with claims from people with one of two common chronic conditions—diabetes and congestiveheart failure.

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Key findings include:

• Those with drug-use disorders were almost 13 percentage pointsmore likely to have out-of-network hospitalizations and more than15 percentage points more likely to experience out-of-networkoutpatient care than those with congestive heart failure.
• Enrollees with mental health conditions had cost-sharingpayments for out-of-network care that were $341 higher per year onaverage than enrollees with diabetes.
• Compared to people with diabetes, those with drug-use disorderspaid $1,242 more per year on average for out-of-network care andthose with alcohol-use disorders paid $1,138 more.

"Much of this disparity is likely due to the limitedavailability of behavioral health care providers in insuranceplans—the participation rates by these providers are generally low,a problem that is fueled in large part by low reimbursement ratesfor clinicians, including psychiatrists," Xu writes in theuniversity's blog post about the study. "We saw thatpeople with heart failure and diabetes didn't go out of network asoften and didn't pay nearly as much for their care, probablybecause they were able to find care within the network," shewrites.

Cost sharing for out-of-network care represents "a substantialfinancial burden" to patients with behavioral conditions, "and itmay be an important sign of network inadequacy that requires morescrutiny from policy makers," the study concludes.

Policymakers apparently agree—both public and private.

On the same day (Nov. 6) the study was published, the Centersfor Medicare & Medicaid Services announced the approval of a"first-of-its-kind Medicaid" demonstration project that broadenstreatment services available to Medicaid beneficiaries living inthe District of Columbia diagnosed with serious mental illnessand/or serious emotional disturbance. At the same time, CMS isapproving the District's request to begin providing new servicesfor its beneficiaries diagnosed with substance use disorder.

"For too long, our system has failed to provide Americans withserious mental illness and their families the treatment andassistance that they need," HHS Secretary Alex Azar writes in theCMS press release. "Americans with serious mental illness too oftenend up homeless or in our prisons, when access to treatment couldhelp them lead healthy lives."

Improving access to behavioral health services is also top ofmind for private payers, according to Health Payer Intelligence.For example, Blue Cross Blue Shield of Rhode Island is partneringwith Bradley Hospital in East Providence to mitigate pediatricpsychiatrist shortages in their region.

"A non-for-profit in the Lifespan health system in Rhode Island,Bradley Hospital hosts the PediPRN initiative, which provides aconsultation team of child psychiatrists to provide telehealthsupport to pediatric primary care providers," HPI writes.

Read more: 

• Behavioral health claims jump, driven by youngpeople
• Telemedicine shows potential for addictiontreatment, hurdles remain
• Employees more likely to seek mental health help,but services are lacking