Rising mental health demands require an innovative insurance model

COLUMBUS, OH., May 16, 2023 –  Sidecar Health consumer driven health plans offer robust major medical coverage with first of its kind access and no network restrictions or prior authorizations. In honor of Metal Health Awareness month, the company published an article on how a new approach to health insurance can help the nearly 20% of adults experiencing mental illness get access to care.

As the need for mental health treatment continues to rise, the gap between providers and patients widens. According to the Health Resources and Services Administration, 149 million Americans live in federally-labeled Mental Health Professional Shortage Areas. This deficit is due to increased demand for mental health services and a culmination of issues within traditional insurance models. Inadequate negotiated compensation rates for mental health professionals and increased administrative work associated with insurance claims compared to other medical practices also contribute to the shortage of mental health practitioners.

This shortage may last through 2025, which is far too long for individuals who struggle to receive care. While telehealth services are another option, sometimes they are not covered by traditional insurance, forcing patients to pay out-of-pocket.

The cost of care

Most individuals rely on insurance as the primary resource to cover medical costs. Unfortunately, 45 percent of psychiatrists in the U.S., mainly those in private practice, do not accept health insurance. Due to this disconnect, using out-of-network providers for mental health is over three times more common than in other medical care settings. This lack of coverage and care options means patients must go out of their way to find a physician who accepts their insurance. Many patients either shoulder the costs themselves or become part of the half of U.S. adults who have postponed or skipped care because of cost.

The instant-pay non-network model eliminates many of the hurdles facing patients with traditional insurance. Under this model, patients can compare prices between providers against their benefit amounts and schedule an appointment with any licensed practitioner in their area without network restrictions, referrals or prior authorizations. With Sidecar Health, members know what their plan pays upfront and when providers charge less than what their plan pays, members can keep the difference. The impact- over 80 percent of Sidecar Health major medical mental health claims in 2022 involved members keeping the savings, averaging approximately $50 back in savings each time they saw a mental healthcare provider. The remaining 20% of claims cost members just $30 per visit, on average, other than their deductible.

Increased access and lowered cost of mental health care

Easy access to mental health services is essential care; mental health treatment reduces the risk of chronic diseases tied to stress, anxiety, and substance abuse, resulting in patients requiring other kinds of medical care 90 percent less frequently than they would otherwise. Governor Mike DeWine is prioritizing expanded mental health services in Ohio as one way of addressing the issue.

With instant-pay non-network insurance models, patients can simply access care for mental health conditions with cost transparency and shorter wait times for providers of their choice. These new models are disrupting the industry and offering a new pathway toward solving the longstanding gaps and drawbacks of traditional insurance in mental health treatment.

When given the opportunity to choose their provider, patients are three times more likely to take advantage of mental health benefits and seek treatment. These numbers are amplified even further with instant-pay models. For example, with the Sidecar Health major medical plans, mental health utilization is 1.5 to 2 times the level of utilization typically seen with traditional health insurance plans. This doesn’t mean Sidecar Health members utilize all types of healthcare more frequently, rather the opposite: for the same major medical members, Emergency Room utilization is 30% less than average levels of utilization for traditional health insurance plans.

There are still far too many barriers to accessing mental health care in the United States. Innovative insurance models, such as Sidecar Health can address these issues by expanding patient choice and giving clarity to upfront costs.

The full article is published on the Sidecar Health blog.

Media contact: 
Nicole Maisner
(877) 653-6440
nmaisner@sidecarhealth.com

Sales inquiries: 
Chris Patton
(877) 653-6440
cpatton@sidecarhealth.com

ABOUT SIDECAR HEALTH

Sidecar Health is on a mission to make quality healthcare affordable and accessible to everyone in the US. We believe in a world where you have the freedom to choose any provider, and pricing is understandable and clear. So, we’ve rewired health insurance with a modern, intuitive and tech-forward approach that removes obstacles to excellent care and empowers you with the information you need to make smart decisions about your care.