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

A smiling doctor reviews medical records.

Nearly one in five adults seeking mental health care saw an out-of-network provider within the prior 12 months, more than double the amount of those using general health care.

The Issue:
Choosing an out-of-network provider for both mental and general health care based on perceived quality of the provider, even if it costs more, was one of the most commonly cited reasons. Issues regarding in-network availability, physical location or appointment wait time were less important considerations for voluntarily selecting an out-of-network mental health physician.

Key Findings

  • Eighteen percent of individuals had a least one contact with an out-of-network mental health care provider in the prior 12 months. In comparison, the rate of out-of-network care for general health was 6.8 percent.

  • Areas with high numbers of psychiatrists per capita (19 or higher per 100,000 residents) was positively associated with out-of-network use compared with areas of lower density (<7 per 100,000 residents).

Perceived provider quality or the desire for continuing care with a known provider were among the most commonly cited reasons of seeking mental health care with an out-of-network provider. While data does not specify which type of provider or which type of service, future studies should consider these specifics.

About the Study:
Privately insured adults, ages 18–64, took an internet survey in February 2011 on their use of an out-of-network physician or mental health provider within the prior 12 months. The sample included 849 respondents.