Nearly half of Georgia’s insured children use out-of-network mental health providers

By Ellen Eldridge, senior health care reporter for Georgia Public Broadcasting.

Your insurance company might be paying its network of providers unevenly, which means in-network coverage for behavioral health care is more difficult to find than medical/surgical care.

High out-of-network use is a consequence of health plans contracting with too few providers.

Insurance companies do this to save money, according to research from RTI International.

That many more individuals paid out of network for behavioral health care suggests the networks for behavioral health care are not as robust as for most other kinds of health care, Tami Martin, the lead author on the study, said.

One reason is that psychiatrists and other behavioral providers are reimbursed less than medical/surgical providers, Martin said.

"What we're finding is that health plans will work really hard to get most specialists to participate in their network by paying them adequately," she said, "but they're not really doing that same work for psychiatrists and psychologists and other behavioral health specialists."

When a child in Georgia needs a specialist, in-network psychiatric care is much harder to find than a pediatric surgeon, said Dr. Henry Harbin, a parity expert and advisor on RTI’s study. 

Nationally, insurance companies choose to reimburse some doctors up to 70% more than they offer psychiatrists.

Almost 104 times as many Georgians needed to pay out-of-network for inpatient behavioral health treatment as did those who needed inpatient physical health care.

"The financial burden on a consumer to go to inpatient care or residential care or acute hospital on the psychiatric side is astronomical. You really, you can't afford it," Harbin said.

An estimated 42% of Georgians have to go out of network for residential substance misuse and psychiatric residential treatment for kids.

Paying out of network can mean paying out of pocket.

A two-week stay in such a facility could cost thousands of dollars, Harbin said.

"It's outside the ability of almost anybody to afford," he said.

These huge disparities in out-of-network use make it clear that there is a parity violation," Martin said. "It's not something that is questionable."

State regulators must enforce current laws and hold companies accountable when they commit parity violations, Harbin said.

In Georgia, parity violation complaints can be filed through the attorney general's website.

Tags: Mental Health  Health Care  Georgia Atlanta