Inpatient MH/SUD* treatment occurs out-of-network 4 times more often than inpatient medical care.

Outpatient MH/SUD treatment is more than 5 times as likely to be out-of-network than outpatient medical care.

Delaware

(one of the highest drug overdose rates)

Inpatient MH/SUD treatment: 29 times more likely to be out-of-network than inpatient medical care.

Maine

(suicide rate far above the national average)

Inpatient MH/SUD treatment: Approximately 38 times more likely to be out-of-network than inpatient medical care.

*MH/SUD = Mental Health / Substance Use Disorder

MH/SUD Reimbursement Rates Vs. Other Medical Reimbursement Rates

 

  • The disparity between MH/SUD and other medical providers continues to grow.
  • Primary care providers were paid 24% more than MH/SUD providers for office visits.
  • In 11 states, primary care office visits were reimbursed more than 50% higher than MH/SUD office visits.

States with Highest Proportion of Behavioral Out-of-Network Use for Inpatient Facilities (PPO Plans)