1. National Legislative Landscape

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  2. National Statutory Landscape

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    • Promising
    • Needs Work
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  3. National Regulatory Landscape

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  4. Resources

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  5. Milliman Report

    Disparities in out of network utilization
    and provider reimbursement rates

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    Inpatient Care

    Behavioral health patients are 4x more likely to go out of network

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    Outpatient Facility Care

    Behavioral health patients are 6x more likely to go out of network

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    Outpatient Office Visit

    Behavioral health patients are about 5x more likely to go out of network

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    Provider Reimbursement

    Behavioral health providers are reimbursed an average of 20% less than primary care physicians and 16% less than specialists

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    Milliman Report: Overview

    All States

    On November 30th, 2017 the leading actuarial and consulting firm Milliman released a report that examined out-of-network utilization for behavioral health treatment versus out-of-network utilization for medical and surgical treatment. The report found that in most states people had to receive out-of-network treatment at much higher rates for behavioral health than they did for medical and surgical treatment.

    Additionally, the Milliman report examined the rate at which commercial insurance plans reimbursed providers compared to what Medicare reimburses. The numbers show the disparity between reimbursement rates paid to behavioral health providers vs. reimbursement rates for other medical providers. Any percentage less than 100% means that commercial insurance plans were reimbursing at rates lower than what Medicare pays. Any percentage over 100% means that commercial insurance plans were reimbursing at rates greater than what Medicare pays.

    Disparities in out of network utilization rates and reimbursement rates reflect pressing concerns regarding mental health and substance disorder workforce and access to services. The Milliman Report proves that mental health and substance use disorders are still treated inequitably in America and the realization of parity has yet to be achieved.

    Federal Report

    Milliman State Reports