New York’s attorney general says insurers publish inaccurate ‘ghost networks’ of mental health providers

Have you ever felt that it is unreasonably difficult to find a therapist that will cover your insurance?

It’s not just you, according to a report released Thursday by the office of New York Attorney General Letitia James.

The report found that many state 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 problems.

Health plans are required to have adequate and accurate networks of mental health providers under state and federal law, and James says the plans are falling short of those mandates.

She called the inaccurate lists “ghost webs” and said they force patients to choose between paying out-of-pocket for care or not.

“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.” need,” James said in a statement on the report.

James’ office deployed a team of “mystery shoppers” to scour the directories of 13 different New York health plans and contact at least 20 different mental health providers, each time grouping the calls for a particular insurer within a geographic area. area. Overall, only 14% of calls resulted in a meeting offer.

Results ranged from a 0% success rate when trying to book an appointment with Albany-area providers listed in insurer MVP Health Care to a 35% success rate when trying to book an appointment with New York-area providers in the Cigna directory.

James’ mystery shoppers made efforts to secure appointments for children and adults with various types of mental health providers, including psychiatrists, psychologists, nurses, licensed mental health counselors and social workers, according to her office’s report.

When contacting providers listed as accepting Healthfirst — which serves about 1.7 million New Yorkers through its commercial plans and Medicaid — only one in 20 calls made to mental health providers, or 5 percent, resulted in an offer for meeting. In four cases, callers contacted 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 provider directories are as current 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 Health Plan Association, in a statement on the report. “The challenges facing the behavioral health care system are not unique to New York and are 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 is on par with their coverage for physical health care. But the Biden administration admitted this year that the health plans are still failing, and have been for years.

A study by consulting firm Milliman that examined insurance claims since 2017 found that nationally, behavioral health care office visits are 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 off the grid.

“The time has come for the state to really look [at] how we regulate insurance carriers in this area,” said Elizabeth Benjamin, vice president of health initiatives at the Society for Public Service in New York.

The Community Services Corporation operates an ombudsman program that provides guidance to New Yorkers seeking mental health or addiction services that are covered by insurance.

“It’s terrible when people can’t get timely behavioral health care,” Benjamin said. “People can go into crisis and have terrifying thoughts.”

The James report recommended the state make regulatory changes and increase enforcement against plans that do not comply with the law. This suggests that the state requires plans to conduct regular audits of their networks and that they are regularly subject to secret shopper surveys.

She also suggested requiring plans to maintain certain standards for how long patients have to wait for appointments and to include providers who can provide care for different 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 as Gov. Kathy Hochul says the state faces a shortage of mental health providers, which she has tried to fix in part by providing funding to pay off student loans.

Meanwhile, the state Department of Financial Services, which oversees commercial health plans, is scheduled to propose new regulations on network adequacy for mental health and substance use disorder treatment by the end of the year, according to the James report. The department did not respond to a request for comment on those provisions or the report itself.

This story has been updated to correctly reflect the percentage of calls from “mystery shoppers” that led to psychiatric help, according to a report by Attorney General Letitia James. Overall it is 14%.

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