Insurers are shifting costs to patients and decreasing insurance reimbursement, making it harder for patients to afford mental health care and harder for therapists to make a living.
Health care out of pocket expenses (OOP) increased substantially in 2016 and behavioral health care did not buck that trend. OOP are all expenses borne by the patient be they co-payments, co-insurance costs, deductible costs or any other cost sharing arrangement.
This chart shows the increase in patient OOP as a percent of total reimbursement for all payers(BCBS, commercial, medicare and medicaid). Note psychiatric E&M codes rose along with therapist codes:
The next chart shows the same trend applies to BCBS and commercial payers:
This chart shows that the trend among all payers is to increase patient responsibility, decrease insurance reimbursement while maintaining the allowable:
This trend is also reflected in BCBS and commercial payer data:
Patient responsibility has increased more for some CPT codes than others. For all payers, the most common CPT code 90834 increased 18.1% between 2015 and 2016; for intakes, 90791, the increase was 26.5%.
For BCBS code 90834 patient responsibility increased 16.1% between 2015 and 2016; for intakes, 90791, the increase was was 17.2%.
*CPT copyright 2016 American Medical Association. All rights reserved.