Narrow Network Plans Offer Less Mental Health Coverage

By Consumers for Quality Care, on September 15, 2017

A recent study found that narrow-network plans offer even more limited mental health care, Reuters reports. Narrow-network plans were created to bring lower-cost health insurance plans to ACA markets. These plans generally limit coverage to fewer than 25 percent of providers in a given market.

The study found that while narrow-network plans cover 24 percent of primary care providers, they cover roughly 10 percent of mental health providers in the same marketplace.

But the tradeoff for lower costs may be less access to mental health care – a breach of both the ACA and federal laws requiring parity between coverage for mental health and other types of care.

Nationwide, only 19 percent of non-physician mental health providers were covered by narrow-network plans, according to the study.

This lack of access could push patients seeking mental health to have to go out of network or pay out of pocket.

The study did not determine why this coverage disparity is happening.  Mental health providers might be incentivized to opt-out of participating in narrow-network plans:

[P]ast research has found that both psychiatrists and non-physician mental health care providers face reimbursements for time-intensive care, like talk therapy, that are far lower than their usual rates, so they have incentive to avoid participating in insurance networks, the authors note.  

While the ACA has expanded mental health coverage for many Americans, the study shows there is still more improvements needed, says Benjamin Le Cook, a researcher from Harvard Medical School.

“However, this study shows that these families and patients need to shop (for) insurance plans carefully on both price and availability of mental health providers,” Cook added. “It may be worth it to them to pay a higher premium to get a mental health provider that can provide the best treatment for them or their family member.”