By Joy Burkhard, MBA

In 2022, with the financial support of the ZOMA Foundation, we ran an analysis of private insurer claim data to better understand the rate at which providers, including Obstetricians, are billing private insurers for screening and treatment services in pregnancy and the postpartum period. The data reflected 2021 claim sets.

The data is represented below in 4 tables which include the top states for each data set.

Table 1A: % of Those who are Pregnant Whose Provider Billed for MH Screening

Table 1B: % of Those who are Postpartum Whose Provider Billed for MH Screening

Table 2A: % of Those who are Pregnant whose Provider Billed for MH Treatment

Table 2B: % of Those who are Postpartum whose Provider Billed for MH Treatment

Summary of Key Findings

The results were not surprising to us and confirmed that very few providers are billing private insurers for screening and treatment of maternal mental health disorders. This is despite the fact that the Affordable Care Act requires private insurers to cover preventive screenings, including requiring depression screening in pregnant and nonpregnant adults since 2017 as recommended by the U.S. Preventive Services Task Force (USPSTF). Any preventive service endorsed by the USPSTF must be covered at no cost-share to the patient.

What people generally fail to understand is that coverage does not equal a provider mandate. So though an insurance benefit may be available under a benefits contract, it doesn’t mean the provider has to provide the benefit.

Our health system is fragmented in many ways, including clinical services not being aligned to practice guidelines, lack of quality oversight and accountability of such delivery, and missing incentives to further support providers in delivering recommended prevention and treatments.

So What Does This Mean for Maternal Mental Health?

This data points out providers are likely administering screening and treatment at suboptimal rates and that providers are not sure if they will be reimbursed for screening by private insurers.

What Should Private Insurers Do?

One simple step private insurers can take is to communicate the screening and treatment billing codes its contracted providers should use for maternal mental health services. This should include informing Obstetricians of the codes they should bill on a fee-for-service basis for services provided outside of the global maternity care capitation rate. Or if these services should be provided through the global capitation rate, informing obstetricians this is the case and when the capitation was last increased to account for this important service being delivered.

One simple step private insurers can take is to communicate the screening and treatment billing codes its contracted providers should use for maternal mental health services. This should include informing Obstetricians of the codes they should bill on a fee-for-service basis for services provided outside of the global maternity care capitation rate. Or if these services should be provided through the global capitation rate, informing obstetricians this is the case and when the capitation was last increased to account for this important service being delivered.

Top Performing States

Regardless of these low rates, it is interesting to note which states have the highest rates of provider billing:

Rhode Island

Rhode Island had the highest rates of providers who billed for maternal depression screening in pregnancy (1.5%) and treatment in pregnancy (18.9%) and who billed for treatment in the postpartum (17.1%) When we studied what has happened in Rhode Island, the Department of Public Health pointed to several programs, but most notably, the state’s mother-baby psychiatric day hospital which supports providers by providing something as basic as a treatment pathway.

Colorado

Colorado had the highest rates of providers who billed for maternal depression screening in the postpartum (at 2.3%, with 1.6% of obstetricians billing). It's important to note, however, that these rates are still very low at roughly 2%. Colorado’s Department of Health and Hygiene was one of the first states to inform pediatric providers how to bill for postpartum depression screening for the Medicaid population, which likely increased rates of private insurer billing as well.

DETAIL

Table 1A: % of Those who are Pregnant Whose Provider Billed for MH Screening
Location: States with highest prenatal screening claim submission (>0.5%, the US average)

PATIENT POPULATION	PROVIDER POPULATION	% POP WHOSE PROVIDER BILLED FOR A MENTAL HEALTH SCREENING
RI Prenatal population	All	1.5%
WA Prenatal population	All	1.2%
MN Prenatal population	All	1.0%
NC Prenatal population	All	0.9%
MI Prenatal population	All	0.9%
PA Prenatal population	All	0.8%
AZ Prenatal population	All	0.7%
NH Prenatal population	All	0.7%
NY Prenatal population	All	0.7%
MA Prenatal population	All	0.7%
OR Prenatal population	All	0.7%
ID Prenatal population	All	0.7%
IL Prenatal population	All	0.6%
UT Prenatal population	All	0.6%
VA Prenatal population	All	0.6%

Table 1B: % of Those who are Postpartum Whose Provider Billed for MH Screening
Location: States with highest PP screening claim submission (>0.8%, the US average)

PATIENT POPULATION	PROVIDER POPULATION	% POP WHOSE PROVIDER BILLED FOR A MENTAL HEALTH SCREENING
CO Postpartum population	All	2.3%
CO Postpartum population	OBs	1.6%
NC Postpartum population	All	1.5%
WV Postpartum population	All	1.4%
IN Postpartum population	All	1.4%
WA Postpartum population	All	1.2%
MA Postpartum population	All	1.2%
MT Postpartum population	All	1.2%
CT Postpartum population	All	1.2%
KS Postpartum population	All	1.1%
MI Postpartum population	All	1.1%
ID Postpartum population	All	1.1%
IL Postpartum population	All	1.1%
MN Postpartum population	All	1.0%
IN Postpartum population	OBs	1.0%
CA Postpartum population	All	1.0%
AK Postpartum population	All	1.0%
TN Postpartum population	All	0.9%

Table 2A: % of Those who are Pregnant whose Provider Billed for MH Treatment
Location: States with highest prenatal MH treatment rates (>9.1%, the US average)

PATIENT POPULATION	PROVIDER POPULATION	% POP RECEIVED MH TREATMENT & PROVIDER BILLED
RI prenatal population	All	18.9%
MA prenatal population	All	15.5%
VT prenatal population	All	15.1%
NH prenatal population	All	13.9%
ND prenatal population	All	13.3%
WV prenatal population	All	13.2%
WI prenatal population	All	13.0%
MN prenatal population	All	12.9%
OH prenatal population	All	12.8%
OR prenatal population	All	12.3%
ME prenatal population	All	11.7%
AK prenatal population	All	11.7%
IA prenatal population	All	11.4%
PA prenatal population	All	11.3%
KY prenatal population	All	11.3%
MT prenatal population	All	11.0%
IL prenatal population	All	11.0%
MO prenatal population	All	10.5%
MI prenatal population	All	10.4%
OK prenatal population	All	10.4%
IN prenatal population	All	10.4%
DC prenatal population	All	10.2%
HI prenatal population	All	10.1%
MD prenatal population	All	10.0%
CO prenatal population	All	10.0%
ID prenatal population	All	9.9%
NE prenatal population	All	9.8%
DE prenatal population	All	9.8%
NC prenatal population	All	9.7%
SC prenatal population	All	9.7%
WA prenatal population	All	9.4%
KS prenatal population	All	9.4%
NJ prenatal population	All	9.4%

Table 2B: % of Those who are Postpartum whose Provider Billed for MH Treatment
Location: States with highest postpartum MH treatment rates (>8.1%, the US average)

PATIENT POPULATION	PROVIDER POPULATION	% POP RECEIVED MH TREATMENT & PROVIDER BILLED
RI postpartum population	All	17.1%
WV postpartum population	All	13.8%
ND postpartum population	All	13.3%
VT postpartum population	All	12.9%
MA postpartum population	All	12.2%
MN postpartum population	All	10.8%
OR postpartum population	All	10.7%
OH postpartum population	All	10.4%
WI postpartum population	All	10.3%
NH postpartum population	All	10.2%
HI postpartum population	All	10.1%
DC postpartum population	All	9.9%
KY postpartum population	All	9.9%
IA postpartum population	All	9.7%
MT postpartum population	All	9.5%
CA postpartum population	All	9.2%
DE postpartum population	All	9.1%
AR postpartum population	All	9.0%
IL postpartum population	All	8.9%
SD postpartum population	All	8.8%
ME postpartum population	All	8.8%
MO postpartum population	All	8.8%
CO postpartum population	All	8.7%
PA postpartum population	All	8.7%
AK postpartum population	All	8.7%
WA postpartum population	All	8.6%
NC postpartum population	All	8.6%
WY postpartum population	All	8.5%
MD postpartum population	All	8.3%
MI postpartum population	All	8.3%
NE postpartum population	All	8.2%
UT postpartum population	All	8.2%

About FAIR Health

FAIR Health's mission is to help understand your healthcare costs and health coverage and to bring transparency to healthcare costs and insurance. The nation's largest health plans rely on FAIR Health to store, de-identify, aggregate and analyze their claims. FAIR Health is an independent nonprofit that collects data for and manages the nation's largest database of privately billed health insurance claims.