New York Attorney General Letitia James has unveiled a concerning trend in the state’s health plans, exposing inaccurate information in mental health provider directories.
In a report released on Thursday, James termed these inaccuracies as “ghost networks,” where health plans list mental health providers as “in-network” when they may not accept the specified insurance, have non-working contact details, or are not accepting new patients.
This revelation comes as a significant barrier for patients seeking mental health care, forcing them to choose between paying out-of-pocket or forgoing essential services.
Under state and federal laws, health plans are obligated to maintain accurate and sufficient networks of mental health providers. However, James asserts that these plans are not in compliance with these mandates, hindering New Yorkers’ access to critical mental health care, particularly the most vulnerable individuals.
Study Reveals About Ghost Networks
James’ office conducted an investigative study, deploying a team of “secret shoppers” to assess the directories of 13 different health plans in New York. These secret shoppers contacted at least 20 mental health providers associated with each insurer, revealing that only 14% of the calls resulted in an appointment offer.
The success rates varied widely across different plans, from 0% for MVP Health Care in the Albany area to 35% for Cigna in the New York City area.
The secret shoppers targeted providers serving both children and adults, including psychiatrists, psychologists, nurse practitioners, licensed mental health counselors, and social workers. The report highlights that the challenges in accessing mental health care are pervasive, affecting various provider types and age groups.
One particularly concerning finding was related to Healthfirst, a plan serving about 1.7 million New Yorkers through commercial and Medicaid plans. Only 5% of the calls made to mental health providers listed under Healthfirst resulted in an appointment offer, with instances where callers seeking appointments for children were informed that those providers only served adults.
The New York Health Plan Association, representing health insurers, defended its members in response to the report. Eric Linzer, the president of the Health Plan Association, stated that health plans work diligently to maintain up-to-date and accurate provider directories. He emphasized the challenges in the behavioral health care system, attributing them to widespread workforce shortages.
The federal Mental Health Parity and Addiction Equity Act of 2008 mandates health plans to offer mental health coverage equivalent to their physical health care coverage. However, the Biden administration acknowledged this year that health plans are still falling short of meeting these requirements.
A national study by the consulting firm Milliman revealed that office visits for behavioral health care were significantly more likely to be out-of-network compared to primary care visits. In New York, this likelihood was even more pronounced, with behavioral health care visits being 11 times more likely to be out-of-network.
Elisabeth Benjamin, Vice President of Health Initiatives at the Community Service Society of New York, emphasized the urgency for the state to reevaluate how it regulates insurance carriers in the mental health care domain. Benjamin highlighted the severe consequences when individuals are unable to access behavioral health care promptly, often leading to crises and distressing thoughts.
James’ report recommends regulatory changes and increased enforcement against plans that fail to comply with the law. The suggestions include regular audits of provider networks and implementing secret shopper surveys as part of ongoing monitoring efforts.
In light of these revelations, the state of New York faces a critical juncture in ensuring that mental health care remains accessible, accurate, and in compliance with regulatory standards. Advocates and policymakers are urged to address the systemic issues in mental health provider directories to safeguard the well-being of New Yorkers.
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