Even with longstanding federal parity laws in place, new research highlights an unsettling truth: behavioral health professionals are being systematically underpaid. A recent study by RTI International, commissioned by The Bowman Family Foundation, reveals that behavioral health clinicians are reimbursed at rates 22% lower than their medical and surgical counterparts—a clear violation of the principles behind behavioral health reimbursement parity.
For providers navigating a mental health crisis with surging demand and burnout, these findings validate what they’ve long known: parity is more theory than practice. For payers and regulators, it’s a critical call to action.
Reimbursement Disparities Undermine Mental Health Access
The study found that, on average, behavioral health clinicians are reimbursed 22% less than their medical peers. This disparity isn’t just a matter of professional equity—it has real consequences for patient access and outcomes. Fewer providers participate in insurance networks, forcing patients to pay out-of-pocket or skip care altogether.
Dr. Henry Harbin, senior advisor to The Bowman Family Foundation and a leading expert on behavioral health reimbursement parity, called out the troubling reality:
“The idea that you would pay a mid-level, master’s level physician assistant more than an MD psychiatrist is very telling. It’s a statement of the priorities of the health plans.”
Patients Face High Out-of-Network Costs
The impact of low reimbursement rates ripples outward—directly affecting patients. The study found that patients seeking behavioral health services were 3.5 times more likely to go out-of-network than those seeking general medical care.
Key findings include:
- Psychiatry: 15.3% out-of-network usage
- Psychology: 18.2% out-of-network usage
- Residential behavioral care: 19.9 times more likely to be out-of-network than other medical services
- Primary care (for comparison): only 2.2% out-of-network usage
When families are asked to pay thousands of dollars for out-of-network behavioral health services—often in moments of crisis—they’re forced to choose between their finances and their health.
“If it’s out-of-network and they say, ‘I’m going to have to pay $1,000 to send my child to residential substance abuse disorder treatment,’ they’re not going to get the care,” said Dr. Tami Mark, the study’s lead author.
The research strongly indicates that achieving behavioral health reimbursement parity is essential not only for providers but also for making treatment financially accessible to patients.
Provider Shortages Aren’t the Real Problem
One of the most commonly cited explanations for behavioral health access issues is provider shortages. But the data tells a more nuanced story.
According to the U.S. Health Resources and Services Administration, there are 25% more shortage areas for primary care than for mental health. And yet, out-of-network use remains far higher in behavioral health.
“If we’re paying them equivalent—not 22% less—and there’s still a disparity, that would be more credible,” said Mark. “But the whole picture together, the argument that this is driven by a shortage doesn’t hold water.”
The real culprit appears to be uneven reimbursement—proving once again that improving behavioral health reimbursement parity is the most actionable lever for change.
Nearly a Decade with No Progress
Even more concerning is the finding that the situation has barely improved since a similar study in 2013. Despite growing awareness, stronger parity laws, and a national mental health crisis, reimbursement and network disparities remain essentially unchanged.
“One of the main goals of the parity law … was to equalize the financial burden on patients,” Harbin said. “These results show you that for nine years there have been massive disparities.”
The failure to enforce behavioral health reimbursement parity is not just a bureaucratic lapse—it is a structural failure with enormous human costs.
A Roadmap for Fixing Parity Failures
The RTI study doesn’t just diagnose the problem—it offers a set of tangible solutions aimed at finally achieving behavioral health reimbursement parity:
- Raise reimbursement rates for behavioral health services to incentivize more providers to participate in networks.
- Expand behavioral health provider networks within insurance plans.
- Standardize terminology and reporting templates to help identify and fix parity violations more easily.
- Empower regulators with greater enforcement tools, including penalties for noncompliance.
- Increase transparency by requiring health plans to publish reimbursement and network adequacy data.
Dr. Harbin posed a critical question:
“How many years does it take to comply with a law that’s fairly clear?”
Clearly, without stronger enforcement and financial incentives, behavioral health reimbursement parity will continue to lag behind.
Providers: Use This Data as Leverage
For behavioral health providers, the report offers powerful new leverage. The message to health plans is simple:
“I want to be in-network. I want to be reimbursed fairly. Let’s do what’s right for our patients.”
But the burden can’t fall on individual clinicians alone. As Dr. Harbin emphasized, parity appeals are complex and time-consuming. The fight for fair pay must be supported by professional associations, coalitions, and consumer advocacy groups.
These groups now have a new tool—hard data from a trusted source—to push for behavioral health reimbursement parity at scale.
Why Behavioral Health Reimbursement Parity Matters
Behind every statistic in this study are real people—families who delayed therapy, young adults who skipped rehab, children who didn’t receive life-saving treatment because it wasn’t affordable or in-network.
Behavioral health reimbursement parity is not just about numbers on a spreadsheet. It’s about ensuring that mental health care is treated as essential, not optional. As the U.S. faces rising rates of anxiety, depression, suicide, and substance use, closing this parity gap is a moral, clinical, and economic imperative.
The RTI International study is a clarion call. It offers data, clarity, and actionable recommendations. What remains is the will to act—by regulators, payers, and the broader healthcare community.
Conclusion: Time for Action, Not Excuses
For more than a decade, the promise of behavioral health parity has gone unfulfilled. The findings from RTI International prove that the gap remains wide—and it is hurting both providers and patients.
But there is a way forward. By adopting the report’s recommendations, enforcing existing laws, and committing to behavioral health reimbursement parity, we can build a system where mental health is not an afterthought—but a fully supported pillar of health care.
