Cost-Sharing Disparities for Out-of-Network Care for Adults With Behavioral Health Conditions

Key Points Question What are the differences in out-of-network care for private insurance plan enrollees with behavioral health conditions compared with enrollees with chronic physical conditions? Findings In this cross-sectional study, analyses using a large commercial claims database indicated that the cost sharing from out-of-network care among those with behavioral health conditions was significantly higher than payments for those with other prevalent chronic physical conditions. Among those with behavioral health conditions, rates of out-of-network care were higher for behavioral clinicians and facilities than for nonbehavioral sources. Meaning Despite parity laws, disparities in out-of-network care and cost sharing for those with behavioral health conditions may create undue financial burdens and reflect access-to-care barriers.