Abstract
More than half of Americans with insurance coverage for mental health services are enrolled in plans that carve out behavioral health care services with a vendor specializing in the management of these services. However, utilization management has not taken the place of benefit limitations. Do benefit limits matter? This article reports the percentage of enrollees in managed behavioral health care carve-out plans that encounter benefit limits. Estimates are provided on the impact and savings of imposing benefit limits on enrollees in unrestricted plans. Costs to eliminate benefit limits are estimated to be very small. This study finds that benefit limits do matter but only to a very small number of plan enrollees. Furthermore, the results of this study show that for inpatient limits, children are especially vulnerable. These issues have important implications for discussions about the impact of managed care in mental health and for discussions concerning parity legislation.
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Peele, P.B., Lave, J.R. & Xu, Y. Benefit limits in managed behavioral health care: Do they matter?. The Journal of Behavioral Health Services & Research 26, 430–441 (1999). https://doi.org/10.1007/BF02287303
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DOI: https://doi.org/10.1007/BF02287303