Key Data Points from Milliman Report

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.

New Hampshire

(one of the highest drug overdose rates)

Inpatient MH/SUD treatment: 10 times more likely to be out-of-network than inpatient medical care.

Utah

(suicide rate far above the national average)

Treatment in an outpatient facility: nearly 20 times more likely to be out-of-network than medical care in an outpatient facility.
*MH/SUD = Mental Health / Substance Use Disorder

Commercial Insurer Reimbursement Rates Vs. Medicare Reimbursement Rates

  • Medical providers: paid between 11-15% more than what medicare pays.
  • MH/SUD treatment providers: paid almost 5% less than what Medicare pays.
  • Primary care services for medical care: paid 21% more than MH/SUD treatment services.

Commercial Insurer Reimbursement Rates Vs. Medicare Reimbursement Rates