title: Out-of-network provider use more likely in mental health than general health care among privately insured.
abstract: OBJECTIVE
  Previous research has shown relatively high use of out-of-network mental health providers, although direct comparisons with rates among general health providers are not available. We aimed to (1) estimate the proportion of privately insured adults using an out-of-network mental health provider in the past 12 months; (2) compare rates of out-of-network mental health provider use with out-of-network general medical use; (3) determine reasons for out-of-network mental health care use.
  
  
  METHODS
  A nationally representative sample of privately insured US adults was surveyed using the internet in February 2011. Screener questions identified if the participant had used either a general medical physician or a mental health professional within the past 12 months. Respondents using either type of out-of-network provider completed a 10-minute survey on details of their out-of-network care experiences.
  
  
  RESULTS
  Eighteen percent of individuals who used a mental health provider reported at least 1 contact with an out-of-network mental health provider, compared to 6.8% who used a general health provider (P<0.01). The most common reasons for choosing an out-of-network mental health provider were the physician was recommended (26.1%), continuity with a previously known provider (23.7%), and the perceived skill of the provider (19.3%).
  
  
  CONCLUSIONS
  Out-of-network provider use is more likely in mental health care than general health care. Most respondents chose an out-of-network mental health provider based on perceived provider quality or continuing care with a previously known provider rather than issues related to the availability of an in-network provider, convenient location, or appointment wait time.
authors.affiliation: Department of Population Health, New York University School of Medicine, New York, NY 10016, USA. kyanko.kelly@gmail.com
authors.forename: Kelly A
authors.initials: KA
authors.lastname: Kyanko
authors.forename: Leslie A
authors.initials: LA
authors.lastname: Curry
authors.forename: Susan H
authors.initials: SH
authors.lastname: Busch
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data*; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data*; D008297:Male; D008605:Mental Health Services / Q000706:statistics & numerical data; D008875:Middle Aged; D012737:Sex Factors; D012959:Socioeconomic Factors; D014481:United States; D055815:Young Adult