Beneficiaries Likely to Spend More, Go Out of Network for Behavioral Health Services

Despite the push for parity, Americans are more likely to go out of network and pay higher out-of-pocket costs for behavioral health care treatment than for treatment of chronic conditions such as diabetes and congestive heart failure. 

That’s according to research out of Ohio State University published in JAMA Network Open.  The findings illustrate the roadblocks American face in accessing behavioral health services, and in turn, the challenges providers face in offering them. 

For the study, researchers analyzed claims from about 3.2 million people with mental health conditions, more than 321,000 people with drug use disorders and more than 294,000 people with alcohol use disorder. They then compared those to diabetes and congestive heart failure claims. 


“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,” lead author Wendy Yi Xu told Ohio State News.

For example, beneficiaries with drug use disorders and alcohol use disorders paid an average of $1,242 and $1,138 more, respectively, per year on out-of-network care compared to people with diabetes, according to the findings.

Additionally, people with mental health conditions spent $341 more per year on cost-sharing payments for out-of-network care than people with diabetes. 


“Much of this disparity is likely due to the limited availability of behavioral health care providers in insurance plans,” Xu said. “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.” 

In addition to creating access issues, low reimbursement within the behavioral health care industry has also been cited as a factor contributing to the nationwide shortage of behavioral health workers.

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