NAMI Survey Report: Too Many Gaps in Mental Health Insurance Coverage

Posted on November 15, 2016

ARLINGTON, Va., PRNewswire-USNewswire -- A report by the National Alliance on Mental Illness (NAMI)  reveals new information about the gap between health insurance coverage of mental health and substance abuse conditions and that of other medical conditions.

Out-of-Network, Out-of-Pocket, Out-of-Options: The Unfulfilled Promise of Parity focuses specifically on the limits of in-network mental health care providers and excessive out-of-pocket costs for people seeking mental health care.

"Despite federal law, discrimination still exists in health insurance coverage of mental health conditions when compared to other medical conditions," said NAMI CEO Mary Giliberti.

"When you have cancer or heart disease, you expect to find specialists in your insurance network.  Mental illness should be no different. The 64 million children and adults who experience mental health conditions in any given year deserve better."

The report is available at www.nami.org/parityreport.

The report is based on a survey of 3,081 individuals with mental health conditions and mental health caregivers conducted in winter 2015. Report findings include:

• One in four people did not have a mental health therapist in their insurance network.
• People were 2.5 times more likely to have problems finding a psychiatric hospital that would accept their insurance compared to other types of hospital care.
• One in four individuals had difficulty finding a residential mental health facility that would accept their insurance.
• Eight in ten people were confronted with out-of-pocket costs of over $200 for psychiatric hospital or residential mental health care compared to fewer than six in ten for general hospital care.
• State Medicaid programs had higher rates of using in-network providers than people with private health insurance plans—contrary to common beliefs.

One major problem facing expansion of the insurance networks for mental health care is the fact that about 45% of psychiatrists do not participate in insurance plans.  Reasons include low reimbursement rates, heavy administrative burdens, and the fact that mental health providers spend more time with patients than other providers. Many operate small or solo practices.

Another problem is the fact that people have difficulty getting accurate information about mental health professionals who participate in insurance networks. Survey respondents complained about making multiple phone calls only to find that listed providers were not accepting new patients, no longer accepted their insurance, were no longer in practice or were deceased.

NAMI recommends that insurance companies be required to take the following steps to improve coverage under federal parity law:

• Maintain accurate, up-to-date directories of mental health professionals
• Provide easy-to-understand information about mental health benefits
• Promote integration of mental health and other medical care
• Expand networks of mental health providers
• Cover out-of-network care to fill gaps in providers