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Out-of-Network Provider Use More Likely in Mental Health than General Health Care Among Privately Insured

Kyanko, Kelly A. MD, MHS*; Curry, Leslie A. PhD, MPH; Busch, Susan H. PhD

doi: 10.1097/MLR.0b013e31829a4f73
Original Articles

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.

*Department of Population Health, New York University School of Medicine, New York, NY

Department of Health Policy and Management, Yale School of Public Health, New Haven, CT

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Presented as an abstract for poster presentation at the 23rd Annual United Hospital Fund Symposium on Health Care Services in New York: Research and Practice, October 24, 2012.

Supported by a grant from the Women’s Health Research at Yale Pilot Project Program and funding from the Yale Robert Wood Johnson Foundation Clinical Scholars Program. The sponsors were not involved in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript.

K.A.K. has accepted consulting fees from the Consumers Union, a nonprofit organization dedicated to consumer protection and FAIR Health Inc., an independent, nonprofit organization with the mission to ensure fairness of out-of-network reimbursement. These consulting activities are in topic areas outside of the submitted manuscript, but both entities may be perceived to have interest in the manuscript content. S.H.B. serves on the Scientific Advisory Board of FAIR Health Inc., and has received payment for that service. L.A.C. declares no conflict of interest.

Reprints: Kelly A. Kyanko, MD, MHS, Department of Population Health, New York University School of Medicine, 227 E. 30th St., Room 646, New York, NY 10016. E-mail: kyanko.kelly@gmail.com.

© 2013 by Lippincott Williams & Wilkins.