New York cracking down on insurers’ 'ghost providers' amid mental health crisis
Shortly after the Biden Administration made a push for mental health care parity comes a report from the New York Attorney General that health insurers are failing to provide access to mental health care to consumers.
A new report from the New York Attorney General said that insurance companies are failing to provide access to mental health care to consumers in that state. The new report, “Inaccurate and inadequate: Health plans’ mental health provider network directories,” surveyed nearly 400 mental health providers who appeared in health plan networks and found that 86% were unreachable, not-in-network, or not accepting new patients.
These “ghost” providers are a symptom of a health system that is not providing adequate access to much-needed mental health services, the AG said.
“No one who reaches out to mental health professionals listed by their insurance company should be told that the providers are unreachable, not accepting their insurance, or not accepting new patients,” said New York Attorney General Letitia James. “Our state is facing a mental health crisis, and this report clearly shows that insurance companies are failing to help New Yorkers in need. 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 forego the care they need. I am calling on health plans to rapidly address this problem and help us tackle the mental health care crisis.”
James has made national headlines in her ongoing financial fraud case against the Trump Organization. But this issue has a much more personal impact on millions of New York state residents who may be seeking mental health treatment.
The investigation by James included a statewide review of 13 health plans: Aetna, CDPHP, Cigna, Emblem, Empire BlueCross BlueShield, Excellus, Fidelis, Healthfirst, Independent Health, MetroPlus, Molina, MVP, and UnitedHealthcare. According to the report, secret shoppers attempted to schedule an appointment for an adult or child with a mental health provider who was listed by health plans as accepting new patients. Of the 396 providers called across all plans, only 56 providers, or 14% of those contacted, offered appointments. The AG’s office found that 86% of providers listed as in-network fit the label as ghost providers, as they were unreachable, not in-network, or not accepting new patients.
New pressure on the insurance industry
This report also comes shortly after the Biden Administration made a renewed push to increase mental health care parity—the idea that mental health services should be as accessible as other medical services.
In July, federal agencies proposed new rules to tighten requirements in this area and do more to
require insurers to show they are following mental parity rules. There have also been efforts to address the “ghost network” issue on the federal level, with Sen. Ron Wyden (D-Ore.) leading the charge with bipartisan legislation that would address a range of issues, including ghost providers.
For their part, insurers say that they are making every effort to provide mental health services and keep directories up to date, but that provider shortages are affecting the industry as a whole.
Albany-based CDPHP scored poorly in the AG’s attempts to locate available providers, with 92% of its listed mental health providers in Albany being designated as ghost providers. The Times Union newspaper of Albany noted that CDPHP is the most common health plan in the area, with 440,000 members.
The Times Union quoted CDPHP spokeswoman Alessandra Skinner as saying that the health plan conducts regular provider surveys and works hard make sure information in the directory is accurate.
“Our provider networks are only as good as the information and the updates that our network is able to provide to us,” Skinner said. “It’s a very much a two-way street … if it says that they’re accepting new patients, we obviously want that information to be updated and available, but we have 1 million providers in our network, so it would be impossible for CDPHP to check up on this on a regular basis.”
Shortages continue to be a problem
States like New York have tried to address provider shortages, which are especially acute in mental health, with steps such as help in repaying student loans for students who train for mental health professions. New York Governor Kathy Hochul recently announced a $5 million expansion of a loan program in New York. Other experts point to the relatively low pay for mental health service providers. In August, Axios quoted David Lloyd, chief policy officer for The Kennedy Forum, as saying that financing issues also play a role in supply.
Related: Mental health benefits: Overcoming hurdles to provide employees with better access to care
“Without a doubt, we need more mental health and substance use providers,” Lloyd said. “No one disputes that. But the payment system is a major cause of that shortage.”
In New York, James released a list of recommendations for moving forward. This included more frequent monitoring of health insurance networks, working to ensure that insurers are keeping their information up to date, enforcement actions for those who do not follow the law, increased incentives to bring in more providers, increased reimbursement rates, and reducing administrative burdens for providers.