A decade ago, congress passed the Mental Health Parity and Addiction Equity Act in the USA which promised to make mental health and substance abuse treatment as accessible as treatment for other conditions. However, in the midst of an opioid epidemic and a spike in suicide rates, this seemingly isn’t the case.

A lack of equality

A national study conducted by Milliman showed that insurers on average paid care providers 20% more for physical care than they paid to addiction and mental healthcare specialists. If therapists stop accepting insurance from mental health patients, fees can jump from USD 25 a session to USD 110 a session. This lack of reimbursement is forcing mental health patients to avoid treatment entirely or severely cut down on sessions.

Treatment for mental health patients can often be more complicated and lengthy than treatment for physical needs. This increase in complexity often leads to a more costly method of treatment. This means that patients with mental health or substance abuse problems are far more likely to face the high, out-of-pocket costs that make treatment unaffordable, even for those with insurance.

The real issue

Many behavioural health clinicians choose not to partner with insurers as a result of low reimbursement rates. This means that insurers are left with only a narrow pool of clinicians who simply cannot keep up with patient demand.

If insurers were to increase their reimbursement rates, it is likely that more clinicians would partner and so more would be readily available to those who need them. At the moment, those in the most vulnerable situations are the ones who are unable to afford the help they really need.

Since the Mental Health Parity and Addiction Equity Act, insurers have made some advances in improving the discrepancies in healthcare coverage. For example, most have stopped the annual limits on the number of visits to therapists that they will cover.

The hope is that having highlighted what the problem is, insurers will look to help those who really need it.