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The Insurance Issue

“More than 70,000 Americans died of overdoses in 2017, yet insurers spent only 1% of their total health care dollars on treatment for substance use disorders — a decrease from two years earlier,” reports Patrick J. Kennedy, author of “Mental health and addiction care are poorly covered by insurance networks.” Kennedy speaks of a new report released by Milliman, an independent actuarial firm. In their study, Milliman researched four categories of treatment: inpatient and outpatient facility services, primary care office visits, and specialist office visits. They then “compared the level of out-of-network use for behavioral health versus physical health. They also examined reimbursement rates for in-network office visits, aggregate spending on behavioral health (mental health and substance use care) as a percentage of total health care spending, and separate disparity details for substance use disorders, children versus adults, and various types of inpatient facilities.” Kennedy says that “the disparities uncovered by Milliman are a cause for great concern.” Read on to find out why.


“Insufficient networks of qualified providers and long wait times for in-network care are forcing people to seek out-of-network care, which equates to higher out-of-pocket expenses.”

To receive treatment from out-of-network providers, “families across the country are depleting savings and retirement accounts, taking out second mortgages on their homes, and just hoping for the best when the money runs out.” In Delaware, for example, a state with one of the highest drug overdose rates in 2017, “inpatient mental health and substance use disorder treatment was approximately 29 times more likely to be out-of-network than inpatient medical or surgical care.” For children, the in- and out-of-network disparities were even worse, with twice as more likely to use out-of-network treatment options than adults. 


The Federal Parity Law “requires insurers to cover treatment for mental health and substance use disorders no more restrictively than treatment for illnesses of the body, such as diabetes and cancer.”

“The Department of Labor is responsible for enforcing parity among employer-sponsored health plans, but currently has only one investigator for every 12,500 plans.” Furthermore, a lawsuit found that the largest managed behavioral health care company in the country developed “medical necessity review criteria that were inconsistent with generally accepted standards of care as well as wrongly influenced by financial incentives to suppress costs.” Kennedy says, “wrongful denials of coverage” will continue because there is not enough oversight and enforcement at the federal level. 


Villa Tranquil Recovery is here for you. We do everything we can to make things fair and honest. Contact us for more information about the programs we offer and what we can do to make this easier on you. Call us now at 214-799-3080