Sarah Bassler Millar Discusses Access to Mental Health Care With Modern Healthcare

In “Why insurers’ mental health coverage falls short,” Modern Healthcare turned to benefits and executive compensation partner Sarah Bassler Millar for insight on insurance coverage of mental health care.

Bassler Millar said insurers might impose prior authorization and step therapy requirements or review claims for medical necessity so long as they apply the same policies to all forms of care. For instance, an insurer that establishes medical necessity standards for experimental medical treatments must use the same standards for behavioral health, she noted.

“The challenge comes in that insurers have developed medical management policies very specific to particular treatments,” Bassler Millar explained. “It’s a complex process to provide parity.”

Bassler Millar also stated that the Department of Labor (DOL) requires insurers to submit reimbursement data for behavioral health providers. “The DOL is asking questions like, ‘How do you determine the provider rates for mental healthcare providers versus [medical and surgical clinicians]?’ ‘What’s the data you’re relying on?’”

Bassler Millar added that commercial insurers generally follow Medicare’s lead when setting payment and coverage policies. If Medicare reimbursed mental health and substance use disorder providers at higher rates, private carriers would likely follow suit, she concluded.

The full article is available for Modern Healthcare subscribers.