New York Attorney General Unveils Alarming Discovery: “Ghost Networks” Plague Mental Health Care Access

New York 'Ghost Network'

Lack of Worrying Mental Health Accessibility

This was revealed to the New York Attorney General, Letitia James, who recently discovered shocking gaps in the ability of their citizens to access mental health facilities.

James’ report shows that there are significant discrepancies on the mental health provider networks as stated by various insurance companies. As a result, patients struggle to access covered mental health services.

Adequate Directories, Distressed Patients

The report reveals that many plans wrongly label providers offering mental health care as in-network.

These providers often do not accept any given insurance, are not taking new patients or have wrong contact information.

This has been termed ‘Ghost Networks’ by James and it forces patients to choose between bearing an out-of-pocket expense for their care or going without.

“We have laws requiring accurate directories that plans must follow,” said Attorney General James.

“By not maintaining accurate directories as required by law, these plans make it harder for New Yorkers, especially the most vulnerable among us, to get mental health care and force them to delay or forgo the care they need.”

Startling Statistics from Undercover Investigation

In order to get deeper into this issue, James’ office carried out an undercover investigation using a team of secret shoppers.

These undercover people went through 13 New York health plan’s directories and tried setting appointments with at least twenty different mental health providers within specified geographic locations. Shockingly, only 14% of the attempts resulted in offer of an appointment.

These rates were varied greatly from Albany area providers listed under MVP Health Care which scored 0% success rate all the way to Cigna’s directory where 35% was recorded for New York City area providers.

Challenges and Advocacy Included in Investigation

The examination involved making efforts to obtain appointments with a variety of doctors including psychiatrists, psychologists, nurse practitioners, licensed mental health counselors (LMHCs), and social workers for both children and adults.

However, this investigation also uncovered that 95% of calls to providers listed as “accepting Healthfirst” ended without a single appointment being offered.

Additionally, some of the callers looking for services for their children found out that such providers only take care of adults.

In defense of insurers, Eric Linzer, Health Plan Association President, pointed out the burdens placed on them by behavioral health workforce shortages that are widespread.

Nevertheless, these arguments fail since the law demands correctly maintained provider directories.

Federal Laws and Persisting Shortcomings

The federal government’s Mental Health Parity and Addiction Equity Act of 2008 mandates health plans to offer mental health coverage similar to coverage provided for medical care.

Nevertheless, it is still acknowledged by Biden administration that it is not meeting those standards consistently as required by these regulations.

Office visits for behavioral health care were much more likely than primary care visits to be out-of-network across the nation as a whole according to a study conducted by consulting firm Milliman.

In New York this disparity was even greater with behavioral health care visits being 11 times as likely to be out-of-network.

Demands for Regulatory Changes

According to Elisabeth Benjamin, vice president of health initiatives at the Community Service Society of New York, the state needs to make regulatory changes to monitor insurance carriers that are operating within the mental health care market.

She illustrated how people suffer from no access to behavioral healthcare on time and indicated they can end up in crises and think suicidal thoughts.

The report by Attorney General James proposes regulatory changes, increased enforcement against non-compliant plans, mandatory network audits and periodic secret shopper surveys.

Setting standards for appointment wait times and including providers serving diverse populations within these networks were also advised.

Addressing Crisis in New York State

Benjamin believes part of the solution is incentivizing health plans to invest more into behavioral health care so that other providers can join their networks.

Acknowledging the shortage of mental health providers in New York State, Governor Kathy Hochul introduced measures like student loan repayment funding.

The New York State Department of Financial Services is preparing a proposal for new regulations on network adequacy for mental health and substance abuse treatment suggesting a possible shift in attitude towards these grave problems.

This report comes out at a time when there is a great need because there is not enough of mental healthcare professionals throughout NY state.

Although attempts are being made to alleviate such disparities, immediate and focused efforts must be taken to ensure all New Yorkers have equitable access to essential psychiatric services.

Mental Health Topics (A-Z)

  • New York Attorney General Unveils Alarming Discovery: "Ghost Networks" Plague Mental Health Care Access