A new University of Pennsylvania study reveals that the average provider network includes only 11 percent of all the mental health care providers on average in a given market. These narrow insurance networks contribute to preventing many who need mental health and addiction treatment in Colorado and elsewhere from getting it.
Narrow networks that do not include most providers can result in long wait times for treatment or no treatment options in many areas. Technically, these conditions violate current laws about the availability of treatment, but there is not any reasonable way to enforce the rules as the system is currently set up.
Why Providers Do Not Join Networks
The obstacles to getting more providers into insurance networks are numerous. First, providers complain that the process for joining a network is difficult and time-consuming. Providers’ applications are routinely rejected for minor mistakes, and providers often give up in frustration before completing the process.
Next, most insurance companies have extremely low reimbursement rates, far below what providers charge customers without insurance. Most businesspeople would not want to have to jump through hoops and spend precious time completing paperwork to get paid less than they normally do for the same service.
The final nail in the coffin is the fact that when they do finally get into a network, providers are inundated with more requests for care than they can possibly handle, which further exacerbates the problem of increased paperwork and decreased pay.
Addiction Treatment and Narrow Networks
The U of P study did not cover addiction treatment specifically, but it is often grouped together with mental health treatment. Furthermore, many people getting addiction treatment also need mental health treatment at the same time, which could increase their costs, if they can even find a provider to accommodate them.
Going out of network is not much of an option either if cost is a factor. Out-of-network providers are allowed to charge more and plan participants are typically responsible for a higher percentage of costs than with in-network providers.
More than 30,000 Coloradoans said that cost was the reason they did not get the mental health care they needed, and although this number has come down in recent years, it is still a significant problem for many with both addictions and mental health symptoms that need treatment.
Are PCPs an Option for Mental Health Care?
The Denver Post notes that primary care physicians have begun to provide an increasing number of mental health services in recent years, and this may be an option for some who need mental health treatment. Primary care physicians are more available in insurance networks—about 25 percent of PCPs were in-network, on average—and can usually get patients into the office faster than other types of providers.
PCPs may be limited in the mental health treatment they can provide, however. They may be able to prescribe medications to treat mental health conditions, but will not likely provide regular or full-length counseling sessions on a regular basis. Not only does such treatment not fit into the normal schedule of a PCP, but they are not trained for it.
Recovery Village at Palmer Lake provides addiction and mental health treatment for those struggling with addiction and co-occurring disorders. Learn about admissions and insurance options available for those who need Colorado rehab services today!