Table 2.
Nonquantitative Treatment Limits for Mental Health Services among Facets Carve‐out Employers: Observed Percent of Plan‐yearsa Requiring Different Penalty Types, and Median and Range among Plans Requiring the Given Penalty
| % Requiring Given Penalty Type, by Parity Period b | Median and Range of Penalty Amount among Plans Requiring the Penalty | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Pre (2008–2010) | Post (2011–2013) | Fisher p‐value | Pre (2008–2010) | Post (2011–2013) | Wilcoxon p‐value | |||||
| n | % | N | % | Median | Range | Median | Range | |||
| In‐network | ||||||||||
| Additional patient coinsurance (percentage) | ||||||||||
| An inpatient hospitalization | 750 | 98 | 1,451 | 98.5 | .485 | 90 | 15–100 | 80 | 50–100 | <.01 |
| Residential treatment | 742 | 98 | 1,451 | 98.5 | .387 | 90 | 15–100 | 80 | 50–100 | <.01 |
| Outpatient psychotherapy | 463 | 67 | 391 | 27.5 | <.01 | 50 | 10–100 | 90 | 20–100 | <.01 |
| Additional patient copayment ($) | ||||||||||
| Inpatient hospitalization | 2 | 0.3 | 0 | 0.0 | .118 | 100 | 100–100 | –c | – | – |
| Residential treatment | 2 | 0.3 | 0 | 0.0 | .116 | 100 | 100–100 | – | – | – |
| Outpatient psychotherapy | 6 | 0.8 | 0 | 0.0 | .001 | 470 | 300–475 | – | – | – |
| Out‐of‐networkd | ||||||||||
| Additional patient coinsurance (percentage) | ||||||||||
| Inpatient hospitalization | 147 | 21.7 | 460 | 33.0 | <.01 | 55 | 10–100 | 60 | 10–100 | <.01 |
| Residential treatment | 140 | 21.1 | 460 | 33.0 | <.01 | 55 | 10–80 | 60 | 10–100 | <.01 |
| Outpatient psychotherapy | 5 | 0.8 | 7 | 0.5 | .537 | 65 | 50–70 | 50 | 5–75 | .249 |
| Additional patient copayment ($) | ||||||||||
| Inpatient hospitalization | 201 | 29.7 | 30 | 2.1 | <.01 | 400 | 100–500 | 350 | 200–500 | .005 |
| Residential treatment | 192 | 28.9 | 30 | 2.1 | <.01 | 400 | 100–500 | 350 | 200–500 | .007 |
| Outpatient psychotherapy | 1 | 0.2 | 0 | 0.0 | .319 | 500 | 500–500 | – | – | – |
NQTLs are only shown for MH‐specific services; there were analogous and almost identically matching limits for SUD services in the same plans.
The unit of observation is the plan‐year. Analysis excludes plan‐years that do not cover a given service, have tiered benefits, and plan‐years with missing data for a particular penalty type.
Preparity (2008–2010; N = 775 plan‐years), postparity (2011–2013; N = 1,482 plan‐years).
No statistics are available—there were no plans with the given penalty in the pre‐ and/or post‐parity period.
Among plan‐years with out‐of‐network benefits: preparity N = 683 plan‐years; postparity N = 1,403 plan‐years.