Outpatient Mental Health Utilization Among Commercially Insured Individuals

In- and Out-of-Network Care

Published in: Medical Care, v. 45, no. 2, Feb. 2007, p. 183-186

Posted on RAND.org on January 01, 2007

by Bradley D. Stein, Robin Meili, Terri Tanielian, David J. Klein

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OBJECTIVE: This study examined the rates and correlates of out-of-network outpatient mental health specialty care. RESEARCH DESIGN: Using administrative data from a large insurer, the authors examine the frequency of out-of-network utilization, analyze demographic and clinical characteristics of individuals receiving out-of-network care, and examine the types of service provided out-of-network. RESULTS: Out-of-network outpatient mental health care was received by 15.4% of adults who used outpatient mental health services, with 11.8% of adult outpatient mental health users receiving only out-of-network care and 3.6% receiving both in-network and out-of-network care. Out-of-network users received significantly more outpatient mental health care than individuals receiving only in-network mental health care. Rates of out-of-network psychotherapy services were substantially greater than for other commonly provided mental health services. CONCLUSION: A significant number of patients covered under this insurer received their outpatient mental health care out-of-network. This is most pronounced for individuals receiving psychotherapy. Further information is needed to improve our understanding of who seeks care from out-of-network providers and why as well as the effect of such care on clinical outcomes.

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