Kentuckians’ access to mental-health care lags behind the nation. Paying providers more would help, psychologists say in report.

By Sarah Ladd

Kentucky Lantern

Kentuckians are far more likely to pay out of pocket for mental and behavioral health services than for surgical or other medical care, except for care in outpatient facilities, where the state is doing better than most states.

This insight comes from a recent American Psychological Association report, which examined health-insurance claims made by millions of Americans who sought care. The report showed that as Covid-19 peaked in the state, the number of Kentuckians forced to go out of their insurance network for acute inpatient care also increased.

Eric Russ, the executive director of the Kentucky Psychological Association, told the Lantern the actual numbers are likely higher than the report reflects because not everyone who seeks out-of-network care will file an insurance claim.

Overall, the report shows that Americans were 10.6 times more likely to go out of their insurance network for psychological care than they were for medical care. The paper cites lower reimbursement rates for mental health care providers as a major culprit.

The report’s findings are “gravely disappointing,” Arthur C. Evans Jr., CEO of the APA, said in a statement. “The federal parity law, the Mental Health Parity and Addiction Equity Act, passed in 2008 and it has still not achieved its goal of equitable access to care for mental health patients.”

“The fact that so many patients are forced to go out of network to receive mental health and substance use care is unacceptable,” said Evans.

The report recommends that states and health-insurance plans expand their behavioral-health networks by raising reimbursement rates, “as they do for medical/surgical providers.” Having access to more in-network providers, the report says, would ease the financial burden on patients who now, if they cannot afford to pay out of pocket, may go without care.

Covid-19 was ‘a sledgehammer’

The report showed that from 2019 to 2021, out-of-network use of inpatient behavioral-health care increased from 2.5% to 4.0% in Kentucky. That’s much higher than the 0.4% reported in 2019 and 0.2% in 2021 for medical and surgical care.

In 2021, Kentuckians were 17.2 times more likely to get out-of network care for behavioral health than they were for medical or surgical care. But the percent of Kentuckians going out of network for outpatient behavioral care care decreased from 2019 to 2021 — 11% to 5%.

“One thing we’ve seen out of Covid is an increase in behavioral health needs,” Russ said. Even before the pandemic, there was an increased need for mental health support. “And then Covid just took a sledgehammer to everybody’s mental health.”

Because there were not enough in-network providers, Kentuckians had to look elsewhere for help, a burden Russ said “falls harder on minority populations.”

“Structural discrimination puts minority populations at an increased risk of mental-health issues generally,” he said. “And then the clinical field tends to be a pretty white-dominated field,” which makes it more difficult to find providers who are culturally competent to treat someone from a particular background or identity.

Lack of access is ‘demoralizing’

Usually when people seek care for a mental-health issue, they’ve often already been struggling for a while, Russ said.

“Usually they’ve been feeling down, depressed, anxious, having relationship problems, having eating disorders for quite a long time before they even start seeking treatment,” he said. “When you start looking, finally ready to get help, and then call your insurance company or call your primary-care provider and say, ‘Hey, where do I go?’ And they give you a list of providers and everybody’s full and you can’t get in — that’s incredibly demoralizing.”

This can add to the stigma that already surrounds mental health issues, Russ said. It can also put people’s well being in jeopardy while they wait for help. This can be worse for people with conditions like ADHD (attention deficit hyperactivity disorder), who may already struggle with organization and time management.

Kentucky is doing slightly better than other states in some categories, the data show.

In particular, the report shows Kentucky was among the states where outpatients were least likely to seek out-of-network behavioral health care, compared to medical-surgical care in such facilities, with only 13 states having a better score than Kentucky in this category.  But Kentuckians were still twice as likely to seek out-of-network behavioral-health care in an outpatient facility as they were to go out of network for outpatient medical-surgical care.

Kentucky also showed slightly better scores than 12 other states when it came to getting out-of-network behavioral-health care, compared to medical-surgical care for inpatient facilities (17.2 times)  and for office visits with a clinician (4.9 times).

“No one is doing well,” though, Russ said. “We have room to go before we have something that looks like real parity between our mental-health and medical systems.”

Kentucky Health News contributed to this story. 

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