NH has biggest gap in coverage for mental health

Dec 05, 2017

BY: Citizens Count

According to a new report, New Hampshire has the largest gap in insurance reimbursement rates for primary care and behavioral health services.

In other words, insurers pay mental health care providers in New Hampshire much less than primary care physicians for an appointment. The gap between behavior health and primary care payment levels in New Hampshire was 69% in 2015.

Click here to learn more about the challenges of mental health care treatment in New Hampshire, including insurance coverage.

There were similarly large gaps in insurance reimbursement rates in Massachusetts (55%), Maine (55%), and Vermont (57%).

Louisiana had the lowest gap in the nation, at -23%. That means behavior health providers in Louisiana were reimbursed more than primary care providers.

The report was prepared by Milliman, an actuarial services company, using two insurance databases covering roughly 42 million individuals.

Federal law on reimbursement for mental health treatment

Federal law requires co-pays, out-of-pocket maximums, and other insurance coverage for mental health treatment to be comparable to coverage for primary care providers. However, insurers can still reimburse mental health providers less than primary care providers.

Unequal payments make it harder to find affordable treatment

Low reimbursement rates discourage mental health care providers from joining an insurance network. The fewer mental health care providers in a network, the more difficult it is for a consumer to find covered mental health treatment. This can push individuals to seek care out-of-network, which has more expensive out-of-pocket costs.

According to Milliman, 53% of behavioral health claims in New Hampshire were out-of-network in 2015. Only three states – Montana, Utah, and Wyoming – had a higher percentage of out-of-network claims for mental health treatment.

Other factors in mental health reimbursement rates

There are many factors that go into the calculation of insurance reimbursement rates. Insurance companies argue they are not discriminating against behavioral health practice – there are reasons for lower reimbursement rates. For example, talk therapy can be provided by a social worker, not just a doctor.

Increasing reimbursement rates would also increase the costs for insurance companies, which in turn increases costs for the consumer.

Do you have an opinion on insurance coverage for behavioral health in New Hampshire? Let us know your thoughts in the comments section below.


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