Mental health (MH) access via insurance providers should be equally easy to access as other medical and surgical treatments. The principle was set into law by the The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPAEA) 2008. However, a recent study by the US Government Accountability Office (GAO) found that America’s insurance providers have been remiss in their duty to conform to this law.

A National Alliance on Mental Illness (NAMI) study in 2017 found that some insurance providers are in flagrant violation of this law, with only 76% of MH patients finding in-network care, compared to 97% of primary care patients. This stark difference in accessibility is caused by many factors including the providers themselves.

James Spencer, Medical Devices Data Scientist at GlobalData, comments: “One significant barrier to getting MH services are the out of date and inaccurate treatment professional directories from the providers themselves. The phone numbers or contact information were found in some cases to be flat-out wrong or lead to professionals who were either no longer taking patients or who had ceased to practice. This is a basic and fundamental failure on the provider’s part to provide a relatively simple function of their job.”

Provision of mental care in America was hugely exacerbated by the pandemic which introduced societal upheaval and levels of unemployment not seen since WW2. The pandemic induced fear, social isolation and the stress and worry of unemployment, with research from the Pew Research Center saying that 21% of US adults are experiencing “high levels of psychological distress”, with almost 30% of adults saying that the pandemic has changed their life in “a major way”.

Spencer continues: “As levels of depression and other forms of psychological distress rise within the population, getting reimbursement for an individual’s mental healthcare plan can only grow in importance, as they become more dependent on mental health professionals support. This issue does not exist solely within the client-provider relationship either. The providers are also failing the professionals directly.”

The reimbursement for MH professionals was found to be on average 23.8% lower than that for primary patients, according to consulting firm Milliman. This directly affected the profitability of those in the MH space and their ability to operate sustainably within provider networks. This has caused many MH providers to work purely out of insurance networks as, even without the network’s supply of clients, they are still more than able to find others who are prepared to pay out of pocket.

Spencer adds: “These two factors highlight a failure on the part of insurance providers to serve both their clients needs and the mental health professionals they are supposed to be serving. Insurance providers should be held accountable if they do not perform the basic tasks for which they are paid, and indeed The Department of Labor (DOL) and Department of Health and Human Services (HHS) have petitioned Congress for greater authority and power in policing noncomplying insurance providers.”