Behavioral Health Services and the Reimbursement Gap: A Recent Study Highlights the Disparity in 2021

A recent study by RTI International sheds light on the growing disparity between patients’ access to behavioral health services and medical/surgical care in 2021. The research found that patients were more likely to seek out-of-network clinicians for behavioral health services, with some choosing providers up to 20 times more often than they would for medical or surgical care.

For example, patients were almost nine times more likely to see a psychiatrist, ten times more likely to see a psychologist, six times more likely for acute inpatient care, and nearly twenty times more likely for sub-acute inpatient care when seeking behavioral health services.

The study also highlighted the impact of reimbursement rates on provider participation in networks. In-network office visits for behavioral clinicians receive lower reimbursement compared to those offered by medical/surgical clinicians. This discrepancy may be creating disincentives for providers to participate in these networks, limiting patients’ access to vital mental health care services.

To address these issues, the study recommends that health plans and states consider increasing reimbursement rates for behavioral clinicians and evaluating reimbursement disparities to ensure parity violations are addressed. By doing so, we can create a more inclusive network of mental health providers and reduce financial burdens on patients seeking these essential services.