The opioid epidemic is booming. Congruently the need for drug treatment is also on the rise. However, according to a new study performed on Affordable Care Act plans by the University of Pennsylvania, the amount of available mental health practitioners within the networks is insufficient. There is a significant narrow network for substance abuse and addiction providers in comparison to primary care providers.
Locally, the study found that 25 percent of primary care providers were included in the network, yet only about 10 percent of local behavioral health providers were listed.
Not only is there a lack of providers in network, there is also a serious disadvantage to individuals in search of health care plans that include mental health. The lack of behavioral health providers within any network, not just limited to ACA plans, is not an uncommon occurrence. Out-of-network behavioral health providers are three times more common than that of general practitioners as the recent study suggests. With out-of-network providers also come higher out-of-pocket costs for the consumer.
This has been the result of the inability to fully actualize the parity requirement of the 2010 Affordable Care Act. Unfortunately, despite the forward progression towards parity, the federal law has been deterred by market factors. These include psychiatrist’s reimbursement formulas being less profitable as compared to physicians. Therefore, in-network behavioral practitioners including psychologists, behavioral specialists, and counselors are few and far behind as they make larger profits outside the network.
For consumers who are considering viable plans, it is important that they check the provider directory as well as ensure their accuracy. Many insurers contract out mental health and addiction treatment to subcontractors and the list of providers may not be up-to-date. This presents a serious disadvantage to uninformed purchasers, yet again.
However, efforts are being made to close the gap between physical health benefits and mental health insurance coverage. With opioid abuse on the rise the need for consumers to easily and affordably access treatment is necessary.