About two-thirds of Americans with a diagnosable mental health issue were unable to seek treatment in 2021, even though they were covered by health insurance. Only a third of those insured who went to the emergency room or hospital as a result of the time of a mental health crisis received follow-up treatment within a month after being discharged.
These are the main findings of an fresh research report by the firm of actuaries Milliman which was which was released on Wednesday. The mental health advocacy organization, Inseparable, commissioned the report, and published an accompanying report that provides policies to fill the gap in the field of mental health.
“We were constantly hearing horror stories of Americans being denied the treatment that they required due to insurance companies were refusing them treatment,” says Bill Smith the founder of Inseparable. “But we did not have enough information to quantify how vast and deep the issue was.”
This report was “illuminating” and timely, according to Meiram Bendat an attorney and psychologist, who was not involved in the writing process. “We’re confronting a topic which is at the front of minds for 9/10 people.”
Although the overall results aren’t shocking, “it is striking that the obstacles to access are what they have always been,” adds Bendat who established PsychAppeal the law firm that focuses on advocacy for mental health insurance. These obstacles include an unsatisfactory workforce, inadequate reimbursement rates for health providers, as well as “substandard application” on consumer rights as well as law that requires insurance companies to offer coverage for mental health problems.
“The findings confirm what many families and acquaintances know: that access to mental health services is a major issue,” says psychologist Benjamin Miller, one of the authors of the policy document. “It’s evident that there are those with identifiable illnesses that aren’t able to find a doctor who can assist them.”
The Milliman report, which analyzed various publicly available surveys and proprietary medical insurance claim data discovered that more than 25% of those with insurance, including Medicaid commercial insurance, Medicare were diagnosed with at minimum one mental health condition in 2021.
A lot of them aren’t treated. In the approximately 50% of Americans who have commercial insurance, less than 30% of people with an addiction or mental health diagnosis have been referred to a behavioral health professional.
The people who are on Medicaid with these diagnosis were the most likely to visit an expert in mental health and 44% of them receiving treatment. Just 15% of people on Medicare were treated for their diagnosis.
It’s something of an “astonishing gaps” in the coverage of mental health Smith says. Smith. “Across all areas there are some numbers that aren’t good.”
The gap in treatment for mental illness, “won’t close unless private insurance companies” adopt measures to improve accessibility to treatment according to him. “We have an extensive way to travel.”
The report also shows that more than 50% of U.S. population lives in areas that are designated to be the Mental Health Professional Shortage Areas and that the nation has less than a third psychiatrists needed to address the demand for providers.
“We haven’t made any progress in increasing the access to employees,” says Miller. “I’ve used the same data point for around 10 years and half of the population lives in an area of mental health care provider shortage zone. It remains the same.”
Their report Miller along with his coworkers propose concrete policies to address the shortage of workers and gaps in coverage of insurance plans, such as increasing utilization of the telehealth service as well as the using peer support specialists.
The authors also suggest offering “competitive cost reimbursement” in the field of mental health professionals.
A different report by Milliman released in the year 2019 has found that mental health professionals are paid less than physical health professionals. “We’ve been aware for some time that there’s an under-reimbursement for health care,” says Bendat.
A solution to the issue of payment disparities will help reduce the burnout of health workers and ensure that more mental health professionals are connected to provide care for the increasing amount of patients in need.
The report suggests that insurance companies be ordered to supply up-to-date and complete directories of providers in their network.
“The issue with these in-network directories is that if you start calling around and inquire from people, ‘Can I meet me? Do you accept any new patients?’ the most of them is that they’re not taking the new patient,” says Miller. “Some directories of providers are outdated enough that you may include people who have stopped practicing.”
However, the requirement that health plans cover out of network health care is important, according to Miller and his coworkers.
“The insurance company has to be able to pay for the cost of your healthcare regardless of whether they have coverage for it or not” Smith says. Smith. “It’s an issue when you’ve got people who make decisions about their health and security of their families, and acting from a state of desperation.”
According to the Milliman report shows that the cost out of pocket of an hour long psychotherapy session was $174. That’s the biggest barrier to accessibility.
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