Mental health care accounts for a growing number of private insurance claims, report finds

Mental health care is accounting for a growing number of private insurance claims, according to a new report out Friday. But experts caution that more than anything else, the new data underscores just how tricky it is to tease out what’s driving increases in mental health care use.

The report found that claims related to depression, anxiety, and a handful of other mental health conditions are on the rise. There were notable increases in those claims among young people, who accounted for a disproportionate share of mental health claims. Experts said the findings could reflect increased access to treatment — but cautioned that it’s difficult to determine the factors at play.

“It’s very hard to disentangle [increased prevalence] from increased recognition, more people accessing care, and people being willing to fill out forms more honestly,” said Dr. Stephen Strakowski, a psychiatrist at the University of Texas at Austin’s medical school. Strakowski, who leads the school’s Center for Youth Mental Health, was not involved in the report.

The report is based on data from FAIR Health, a health care nonprofit with a database of more than 28 billion private health care claim records that the organization said represents 75% of the private insurance market. The authors looked at health insurance claims for behavioral health care, which included both mental health care and substance use disorder treatment. They broke the data down by individual claim lines. A single health care visit can involve multiple claim lines, like a chest X-ray and a breathing treatment.

And while experts said the report comes with caveats, it offers a long-term picture of mental health care use among people with private insurance coverage in the U.S.

“This allows us to take out a glass-bottomed boat into this ocean of claims and be able to document claims associated with [mental health care] trends,” said Robin Gelburd, president of FAIR Health.

The report’s findings among adolescents and young adults were particularly striking. Mental health claims also rose among young people, which the report defined as age 22 or younger. The report also found that young people accounted for a growing share of the claims for major depressive disorder. In 2007, young people accounted for 15% of all claims tied to serious depression. By 2017, they accounted for 23%.

Claims for anxiety also grew more common among young people. Between 2007 and 2017, claim lines for generalized anxiety disorder rose 441% among young people ages 19 to 22. Anxiety-related claims also rose significantly among teens and children.

The report also found that claim lines with behavioral health diagnoses rose 108% from 2007 and 2017. By 2017, they accounted for 2.7% of all medical claim lines in FAIR Health’s database. The most common diagnosis among those mental health claims: major depressive disorder, which constituted 26% of mental health claim lines in 2017. Claim lines for generalized anxiety disorder also climbed significantly during that time.

The findings come with several significant limitations, including that they don’t include people with public insurance coverage or the uninsured. The report also doesn’t detail what types of providers billed for the services or how often people accessed mental health care.

“Even if someone accesses an initial appointment, that doesn’t mean they’re getting adequate treatment. They might go to one therapy appointment, or fill an antidepressant prescription once,” said Dr. Ana Radovic, an adolescent medicine specialist at UPMC Children’s Hospital of Pittsburgh who wasn’t involved in the report.

Experts said there are likely a slew of factors contributing to the increase in mental health care claims among young people. There’s increased awareness about mental health issues and how to identify them. In 2009, the U.S. Preventive Services Task Force recommended universal screening for depression for adolescents age 12 and older. At the same time, clinicians said the stigma around seeking help for some mental health conditions seems to be declining.

“There’s more attention to recognizing the condition, and more attention to improving access to mental health care for kids,” said Strakowski.

Policy changes could also be at play, experts said. The Mental Health Parity and Addiction Equity Act, passed by Congress in 2008, required many insurers to cover mental health and addiction treatment the same way they would medical or surgical care. And the Affordable Care Act allowed young people to stay on their parents insurance through age 26.

“What we’re seeing now is people who need care are more likely to get care,” Strakowski said. But he and other experts noted that there are still serious obstacles to accessing mental health care for many people in the U.S.

“There’s still a lack of people getting services that they need,” Radovic said.