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NY attorney general says insurers posting inaccurate ‘ghost networks’ of mental health providers
By
Caroline Lewis
Published Dec 7, 2023
Modified Dec 7, 2023
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Willie B. Thomas / Getty Images
By
Caroline Lewis
Published Dec 7, 2023
Modified Dec 7, 2023
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Ever feel like it’s unreasonably hard to find a therapist who takes your insurance?
According to a report released on Thursday by New York Attorney General Letitia James’ office, it’s not just you.
The report finds many of the state’s health plans list mental health providers as “in-network” when they either don’t take that insurance, aren’t accepting new patients, or have non-working or incorrect numbers, among other issues.
Health plans are required to have adequate and accurate networks of mental health providers under state and federal laws, and James says plans are not complying with those mandates.
She dubbed the inaccurate listings “ghost networks” and said they force patients to choose between paying out-of-pocket for care or going without it.
“By not maintaining accurate directories as required by law, health plans are making it harder for New Yorkers, especially the most vulnerable among us, to get mental health care and forcing them to delay or forgo the care they need,” James said in a statement on the report.
James’ office deployed a team of “secret shoppers” to go through the directories of 13 different New York health plans and contact at least 20 different mental health providers, each time clustering the calls for a given insurer within a geographic area. Overall, only 14% of the calls resulted in an offer of an appointment.
The results ranged from a 0% success rate trying to book an appointment with Albany-area providers listed under the insurer MVP Health Care, to a 35% success rate trying to book an appointment with New York City-area providers in Cigna’s directory.
James’ secret shoppers made efforts to secure appointments for children and adults with a range of different types of mental health providers, including psychiatrists, psychologists, nurse practitioners, licensed mental health counselors and social workers, according to her office’s report.
When contacting providers that were listed as taking Healthfirst — which serves about 1.7 million New Yorkers through its commercial and Medicaid plans — only one of the 20 calls made to mental health providers, or 5%, resulted in an offer of an appointment. In four instances, the callers reached out to providers who were listed as serving children only to find they only served adults.
The New York Health Plan Association, which represents health insurers, defended its members.
“Health plans work hard to ensure that provider directories are as up-to-date and accurate as possible, which requires a shared commitment from providers to update their information when there are changes in their network status,” said Eric Linzer, president of the Health Plan Association, in a statement on the report. “The challenges facing the behavioral health care system are not unique to New York and have been exacerbated by widespread workforce shortages.”
Under the federal Mental Health Parity and Addiction Equity Act of 2008, health plans must provide mental health coverage that’s on par with their coverage for physical health care. But the Biden administration acknowledged this year that health plans are still falling short, and have been for years.
A study from the consulting firm Milliman that examined insurance claims from 2017 found that, nationally, office visits for behavioral health care were about five times more likely to be out-of-network than primary care visits. In New York, they were 11 times more likely to be out of network.
“The time has come for the state to really take a look [at] at how we regulate the insurance carriers in this area,” said Elisabeth Benjamin, vice president of health initiatives at the Community Service Society of New York.
The Community Service Society operates an ombudsman program that provides guidance to New Yorkers seeking to get mental health or addiction services that are covered by insurance.
“It’s horrible” when people are unable to get behavioral health care in a timely manner, Benjamin said. “People can spiral into crisis and have terrifying thoughts.”
James’ report recommends the state make regulatory changes and increase enforcement against plans that don’t comply with the law. It suggests that the state require plans to conduct regular audits of their networks and that they regularly be subject to secret shopper surveys.
She also suggested requiring plans to maintain certain standards for how long patients have to wait for appointments and include providers who can provide care for diverse populations.
Benjamin said part of the solution lies in health plans paying more for behavioral health care to encourage providers to be in their networks.
The report comes at a time when Gov. Kathy Hochul says the state is facing a shortage of mental health providers, which she has tried to remedy in part by providing funding for repayment of student loans.
Meanwhile, the state Department of Financial Services, which oversees commercial health plans, is slated to propose new regulations on network adequacy for mental health and substance use disorder treatment by the end of the year, according to James’ report. The department did not respond to a request for comment on those regulations or the report itself.
This story has been updated to correctly reflect the percentage of calls by "secret shoppers" that resulted in mental health care appointments, according to a report by Attorney General Letitia James. Overall, it is 14%.
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Health and Science
Caroline Lewis
Caroline Lewis is on the health care beat for WNYC and Gothamist. She has covered COVID, a nurses' strike, the overdose crisis and New York’s marijuana legalization effort, and spent a year investigating patients' medical bills. She always wants to hear about how everyday New Yorkers experience the health system. Got a tip? Email [email protected].
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Gothamist is funded by sponsors and member donations
Gothamist is funded by sponsors and member donations
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