Despite significant efforts to increase access to mental healthcare, insurance firms are pushing back, exploiting legal loopholes and employing cunning strategies to prevent behavioral health institutions from receiving the necessary reimbursement.
Facilities may end up treating a patient at a loss when they are out-of-network, don’t know what their reimbursement rates are, and patients aren’t always able to pay their full share. Because of this, several behavioral health facilities are closing, depriving patients of potentially life-saving therapies.
There is only one option that facilities can completely implement, short of a complete overhaul of the behavioral healthcare sector: making use of technology and compiled data.
We’ll go into great detail on how to use statistics to stay out of debt in this article. It’s crucial to understand how insurance policies relate to facilities first, though.
How Does Insurance Work for Behavioral Health Services?
The Mental Health Parity and Addiction Equity Act of 2008 made it illegal for health insurance companies to place less favorable benefit restrictions on mental health or substance abuse benefits than on medical and surgical benefits; instead, they must cover both behavioral and physical treatments equally, with the same costs and coverage restrictions.
The Affordable Care Act, passed in 2010, required commercial health insurance to provide mental health benefits as part of an effort to reduce high healthcare costs. Any insurance program that provides treatment for mental health must include:
- Mental and behavioral health inpatient services
- Substance abuse treatment
- Behavioral health treatment
Before delivering your services to a patient who might not be able to pay the remaining fees, it’s crucial to understand the limitations and quantities that change depending on a patient’s insurance policy.
Behavioral health billing services play a vital role in assisting behavioral health facilities and providers in managing their billing and revenue cycle processes effectively. These services are specifically designed to meet the unique requirements of behavioral health practices and ensure accurate and timely reimbursement.
How is Insurance Different for Behavioral Health Services?
Certain behavioral health services are covered by insurance in a different way than bodily illnesses are. The level of coverage for behavioral health treatments is typically lower, and more specialized therapies are generally less likely to be covered by most policies.
A 2015 study found that the likelihood of behavioral health being out-of-network was four to six times higher than that of surgical or other types of medical care. Sadly, the majority of insurers don’t disclose their agreements with providers or even have contracts with mental health facilities, so these facilities are unaware of their compensation.
When a facility finds out that insurance won’t cover the costs and the patient can’t afford them, it’s on the hook for treating them. As mental health facilities continue to close because they can’t collect payments and eventually go out of business due to financial difficulties, we’ve seen these effects get worse over time.
Utilization Review and Prior Authorization:
Many insurance plans require utilization review and prior authorization for behavioral health services. Facilities should understand the process and timelines for obtaining prior authorization services to prevent treatment delays and ensure reimbursement. Having dedicated staff members or partnering with experts who specialize in utilization review can help streamline the process and improve authorization rates.
Conclusion
Behavioral health facilities must navigate the intricacies of health insurance to optimize reimbursement and provide accessible care to patients. Understanding insurance coverage and benefits, participating in provider networks, verifying insurance eligibility, ensuring billing and coding compliance, managing utilization review and prior authorization, streamlining claims management, and complying with mental health parity laws are crucial for financial sustainability and operational efficiency.
By equipping themselves with knowledge and resources related to health insurance, behavioral health facilities can enhance their ability to deliver quality care and support the well-being of individuals in need of mental health and substance abuse treatment.
