Outpatient mental health utilization among commercially insured individuals: in- and out-of-network care.
OBJECTIVE
This study examined the rates and correlates of out-of-network outpatient mental health specialty care.


METHODS
Using administrative data from a large insurer, we 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.


CONCLUSIONS
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.
Stein
Bradley D
BD
RAND Corporation, Pittsburgh, Pennsylvania 15213, USA. stein@rand.org
Meili
Robin
R
Tanielian
Terri L
TL
Klein
David J
DJ
D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D007345:Insurance Claim Review; D019458:Insurance Coverage / Q000458:organization & administration*; D007358:Insurance, Psychiatric / Q000706:statistics & numerical data*; D008297:Male; D008605:Mental Health Services / Q000706:statistics & numerical data*; D008875:Middle Aged; D010045:Outpatients