Top

Administration and Policy in Mental Health and Mental Health Services Research

Published in:

01-01-2009 | Original Paper

Benefit Limits for Behavioral Health Care in Private Health Plans

Authors: Dominic Hodgkin, Constance M. Horgan, Deborah W. Garnick, Elizabeth L. Merrick

Published in: Administration and Policy in Mental Health and Mental Health Services Research | Issue 1/2009

Abstract

Data from a nationally representative sample of private health plans reveal that special lifetime limits on behavioral health care are rare (used by 16% of products). However, most plans have special annual limits on behavioral health utilization; for example, 90% limit outpatient mental health and 93% limit outpatient substance abuse treatment. As a result, enrollees in the average plan face substantial out-of-pocket costs for long-lasting treatment: a median of $2,710 for 50 mental health visits, or $2,400 for 50 substance abuse visits. Plans’ access to new managed care tools has not led them to stop using benefit limits for cost containment purposes.

Available only for authorised users

Agency for Healthcare Research and Quality. (2008). Medical expenditure panel survey. Retrieved July 17, 2008, from http://www.meps.ahrq.gov/mepsweb/.

Barry, C. L., Frank, R. G., & McGuire, T. G. (2006). The costs of mental health parity: Still an impediment? Health Affairs, 25(3), 623–634. doi:10.1377/hlthaff.25.3.623.PubMedCrossRef

Barry, C. L., Gabel, J. R., Frank, R. G., et al. (2003). Design of mental health benefits: Still unequal after all these years. Health Affairs Sep-Oct, 22(5), 127–137. doi:10.1377/hlthaff.22.5.127.CrossRef

Barry, C. L., & Sindelar, J. L. (2007). Equity in private insurance coverage for substance abuse: A perspective on parity. Health Affairs. doi:10.1377/hlthaff.26.6w706.

Buchmueller, T. C., Cooper, P. F., Jacobson, M., & Zuvekas, S. (2007). Parity for whom? Exemptions and the extent of state mental health parity legislation. Health Affairs, 483–487. doi:10.1377/hlthaff.26.4.w483.

Daly, R. (2006). Law opens MCO panels to `any willing provider’. Psychiatric News, 41(13), 10.CrossRef

Frank, R. G., & McGuire, T. G.(2003). Economics and mental health. In A. J. Culyer & J. P. Newhouse (Eds.), Handbook of health economics.

Gabel, J., Claxton, G., Gil, I., et al. (2005). Health benefits in 2005: Premium increases slow down, coverage continues to Erode. Health Affairs, 24(5), 1273–1280. doi:10.1377/hlthaff.24.5.1273.PubMedCrossRef

Gabel, J. R., Whitmore, H., Pickreign, J. D., et al. (2007). Substance abuse benefits: Still limited after all these years. Health Affairs, 26(4), w474–w482. doi:10.1377/hlthaff.26.4.w474.PubMedCrossRef

Gitterman, D. P., Sturm, R., Pacula, R. L., & Scheffler, R. M. (2001). Does the sunset of mental health parity really matter? Administration and Policy in Mental Health, 28(5), 353–369. doi:10.1023/A:1011113932599.PubMedCrossRef

Goldman, H. H., Frank, R. G., Burnam, M. A., et al. (2006). Behavioral health insurance parity for federal employees. The New England Journal of Medicine, 354(13), 1378–1386. doi:10.1056/NEJMsa053737.PubMedCrossRef

Hodgkin, D., Horgan, C. M., Garnick, D. W., Merrick, E. L., & Volpe-Vartanian, J. (2007). Management of access to branded psychotropic medications in private health plans. Clinical Therapeutics, 29, 371–380. doi:10.1016/j.clinthera.2007.02.011.PubMedCrossRef

Horgan, C. M., Garnick, D. W., Merrick, E. L., & Hodgkin, D. (in press, forthcoming). Changes in how health plans provide behavioral health services. The Journal of Behavioral Health Services & Research.

Huskamp, H. A. (2005). Pharmaceutical cost management and access to psychotropic drugs: The US context. International Journal of Law and Psychiatry, 28(5), 484–495. doi:10.1016/j.ijlp.2005.08.004.PubMedCrossRef

Kaiser Family Foundation. (2004). Employer health benefits: 2004 annual survey. California: Menlo Park.

Kemper, P., Blumenthal, D., Corrigan, J. M., et al. (1996). The design of the community tracking study: A longitudinal study of health system change and its effects on people, Inquiry. Summer, 33(2), 195–206.

Kronenfeld, J. J. (2003). Organizational variation in the managed care industry in the 1990s: Implications for institutional change. In D. Anthony & J. Banaszak-Holl (Eds.), Reorganizing health care delivery systems: Problems of managed care and other models of health care delivery. Emerald Group Publishing.

LoSasso, A. T., & Lyons, J. S. (2004). The sensitivity of substance abuse treatment intensity to co-payment levels. The Journal of Behavioral Health Services & Research, 31(1), 50–65. doi:10.1007/BF02287338.CrossRef

Mark, T. L., Levit, K. R., Buck, J. A., et al. (2007a). Mental health treatment expenditure trends, 1986–2003. Psychiatric Services (Washington, D.C.), 58(8), 1041–1048. doi:10.1176/appi.ps.58.8.1041.

Mark, T. L., Levit, K. R., Vandivort-Warren, R., et al. (2007b). Trends in spending for substance abuse treatment, 1986–2003. Health Affairs, 26(4), 1118–1128. doi:10.1377/hlthaff.26.4.1118.PubMedCrossRef

Martin, J. K., Pescosolido, B. A., & Tuch, S. A. (2000). Of fear and loathing: The role of ‘disturbing behavior’, labels, and causal attributions in shaping public attitudes toward persons with mental illness. Journal of Health and Social Behavior, 41(2), 208–223. doi:10.2307/2676306.CrossRef

McKusick, D. R., Mark, T. L., King, E. C., Coffey, R. M., & Genuardi, J. (2002). Trends in mental health insurance benefits and out-of-pocket spending. The Journal of Mental Health Policy and Economics, 5(2), 71–78.PubMed

Merrick, E. L., Horgan, C. M., Garnick, D. W., & Hodgkin, D. (2006). Managed care organizations’ use of treatment management strategies for outpatient mental health care. Administration and Policy in Mental Health, 33(1), 104–114. doi:10.1007/s10488-005-0024-0.PubMedCrossRef

Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act. Pub. L. No. 110-343, 122 Stat. 3765 (2008).

Peele, P. B., Lave, J. R., & Xu, Y. (1999). Benefit limits in managed behavioral health care: Do they matter? The Journal of Behavioral Health Services & Research, 26(4), 430–441. doi:10.1007/BF02287303.CrossRef

Research Triangle Institute. (2002). SUDAAN user’s manual: Release 8.0. Research Triangle Park, NC: Research Triangle Institute.

Ringel, J. S., & Sturm, R. (2001). Financial burden and out-of-pocket expenditures for mental health across different socioeconomic groups: Results from healthcare for communities. The Journal of Mental Health Policy and Economics, 4(3), 141–150.PubMed

Sturm, R. (1997). How expensive is unlimited mental health care coverage under managed care? Journal of the American Medical Association, 278(18), 1533–1537. doi:10.1001/jama.278.18.1533.PubMedCrossRef

Sturm, R., & McCulloch, J. (1998). Mental health and substance abuse benefits in carve-out plans and the Mental health parity act of 1996. Journal of Health Care Finance, 24(3), 82–92.PubMed

Sturm, R., Zhang, W., & Schoenbaum, M. J. (1999). How expensive are unlimited substance abuse benefits under managed care? The Journal of Behavioral Health Services & Research, 26(2), 203–210. doi:10.1007/BF02287491.CrossRef

Substance Abuse and Mental Health Services Administration. (2007). Results from the 2006 national survey on drug use and health: National findings. NSDUH Series H-32, DHHS Publication No. SMA 07-4293. Rockville, MD.

US Bureau of Labor Statistics. (2007). National compensation survey: Employee benefits in private industry in the United States, 2005. Bulletin, 2589.

Wang, P. S., Lane, M., Olfson, M., Pincus, H. A., Wells, K. B., & Kessler, R. C. (2005). Twelve-month use of mental health services in the United States: Results from the national comorbidity survey replication. Archives of General Psychiatry, 62(6), 629–640. doi:10.1001/archpsyc.62.6.629.PubMedCrossRef

Zuvekas, S. H. (2005). Prescription drugs and the changing patterns of treatment for mental disorders, 1996–2001. Health Affairs, 24(1), 195–205. doi:10.1377/hlthaff.24.1.195.PubMedCrossRef

Zuvekas, S. H., Banthin, J. S., & Selden, T. M. (1998). Mental health parity: What are the gaps in coverage? The Journal of Mental Health Policy and Economics, 1(3), 135–146. doi:10.1002/(SICI)1099-176X(1998100)1:3<135::AID-MHP17>3.0.CO;2-S.PubMedCrossRef

Zuvekas, S. H., & Meyerhoefer, C. D. (2006). Coverage for mental health treatment: Do the gaps still persist? The Journal of Mental Health Policy and Economics, 9(3), 155–163.PubMed

Title: Benefit Limits for Behavioral Health Care in Private Health Plans
Authors: Dominic Hodgkin
Constance M. Horgan
Deborah W. Garnick
Elizabeth L. Merrick
Publication date: 01-01-2009
Publisher: Springer US
Published in: Administration and Policy in Mental Health and Mental Health Services Research / Issue 1/2009
Print ISSN: 0894-587X
Electronic ISSN: 1573-3289
DOI: https://doi.org/10.1007/s10488-008-0196-5

At a glance: The STEP trials

Springer Medicine

Benefit Limits for Behavioral Health Care in Private Health Plans

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 1/2009

Therapists’ Attitudes Towards Psychotherapeutic Strategies in Community-Based Psychotherapy with Children with Disruptive Behavior Problems

Introduction to the Special Section on Practice Contexts: A Glimpse into the Nether World of Public Mental Health Services for Children and Families

Psychiatric Treatment of Social Disadvantage

Community Treatment of Child Sexual Abuse: A Survey of Practitioners in the National Child Traumatic Stress Network

Evaluation of a Treatment Manual and Workshops for Disseminating, Parent–Child Interaction Therapy

Implementation Research in Mental Health Services: an Emerging Science with Conceptual, Methodological, and Training challenges