2. The high proportion of out-of-network behavioral care means patients with mental health or substance abuse problems were far more likely to face the high out-of-pocket costs that can make treatment unaffordable, even for those with insurance.
3. Still, discrepancies appear to continue in the more subtle ways that insurers deliver benefits, including the size of provider networks. Kate Berry, a senior vice president at America's Health Insurance Plans, the industry's main trade group, says the real problem is the shortage of behavioral health clinicians.

Health plans are working very hard to actively recruit providers and offer telemedicine visits in areas with shortages, says Berry. "But some behavioral health specialists opt not to participate in contracts with providers, simply because they prefer to see patients who are able to pay out of their pocket and may not have the kind of severe needs that other patients have."
4. In Virginia, the Milliman report found that 26 percent of behavioral health office visits were out-of-network — more than seven times more than for medical care. With no alternative, Carlin stuck with her old therapist but now has to save up between sessions. She has just enough to cover a visit once every few months. "I make $30,000 a year," Carlin says. "I can't afford an out-of-pocket therapist or psychiatrist. I just can't afford it. I'm choosing groceries over a therapist." Angela Kimball, the director of advocacy and public policy at the National Alliance on Mental Illness, says she worries many patients like Carlin simply forgo treatment entirely. "One of the most common reasons people give of not getting mental health treatment is the cost," Kimball says. "The other is not being able to find care. It's hurting people in every corner of this nation."


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