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Milliman Report

Disparities in out of network utilization and provider reimbursement rates
Inpatient Care
Inpatient Care
Inpatient Care
Inpatient Care

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

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

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

Behavioral health providers are reimbursed an average of 19% less than primary care physicians and 16% less than specialists

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All States

On November 20th, 2019 the leading actuarial and consulting firm Milliman released a new report that updated data from a previous 207 report. This new report once again examines 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 new Milliman report again 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 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.