January 2009, Volume 36, Issue 1, pp 15-23
Date: 27 Nov 2008
Benefit Limits for Behavioral Health Care in Private Health Plans
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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.
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., & 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.
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.
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.
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.
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
Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act. Pub. L. No. 110-343, 122 Stat. 3765 (2008).
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., & 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
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., & 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
- Benefit Limits for Behavioral Health Care in Private Health Plans
Administration and Policy in Mental Health and Mental Health Services Research
Volume 36, Issue 1 , pp 15-23
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