Ghost networks of psychiatrists and other mental health professionals exist in the U.S. They lurk in the darkest regions of the online world, in the form of your insurance company’s database of providers.
This is the first place most people go to in order to figure out who to call to get mental health treatment. Guess what? The databases are so out of date and inaccurate, the vast majority of time, you will not be able to access a psychiatrist or other mental health professional.
If your health insurance company cared about your access to mental health treatment, naturally they would work hard to ensure their databases are up-to-date and as close to 100 percent accurate at all times. After all, it’s not difficult to do; I can think of at least a half-dozen inexpensive methods to do it.
But even an inexpensive method translates into lost profits in the eyes of your insurance company. So it’s just easier to let the databases languish and be inaccurate. It has the added benefit of discouraging its customers from actually using the insurance they’re paying for. Who’s going to notice? Who’s going to complain?
Jack Turban over at Stat noticed and recently shared with its readers some of the research conducted in this area:
In a recent study, researchers called 360 psychiatrists on Blue Cross Blue Shield’s in-network provider lists in Houston, Chicago, and Boston. Some of the phone numbers on the list were for McDonald’s locations, others were for jewelry stores. When the researchers actually reached psychiatrists’ offices, many of the doctors didn’t take Blue Cross Blue Shield insurance or weren’t taking new patients. After calling every number twice, the researchers were unable to make appointments with 74% of providers on the list.
In a similar study among pediatric psychiatrists, researchers were unable to make appointments with 83% of the providers listed as in-network by Blue Cross Blue Shield.
Other studies have found similar problems with other insurance companies’ databases, too. It’s not unique to Blue Cross Blue Shield.
It’s probably even worse for other providers, since Blue Cross Blue Shield is often held up as one of the gold standards of health insurance companies. If they can’t get this simple thing right, how could others?
This isn’t an unknown issue to insurance companies:
As Massachusetts state Sen. Cindy Friedman, who has been working to get insurance companies to improve their provider lists, told me, “They’ve known about this for a long time and they haven’t done anything about it. It’s difficult not to assume that this kind of barrier is intentional.”
I’ve had friends who’ve complained about this to me for years. They try and try to find a psychiatrist or therapist that is accepting new patients, and the answer is repeatedly, “No.” Even though their insurance company’s database says that they are. I’ve experienced this myself, having to call more than two dozen providers looking for an open psychiatrist or therapist specializing in a certain condition. It’s not a rare issue — it’s the status quo.
Your Insurance Company Doesn’t Seem to Care About Your Mental Health
In short, insurance companies are limiting access to care by keeping their databases out-of-date, showing far more providers are accepting new patients than they actually have. If they showed the real numbers in their database, people would see virtually no availability for a psychiatrist within 20 or 30 miles of their house (unless they happened to live in a large metropolitan area like New York).
Then they outright lie to everyone when asked about the issue. They say, “No, no, we work hard to keep these lists up-to-date. It’s just really hard.” It’s not. It’s incredibly simple to keep such a list updated — they’re just not willing to expend the resources to do it.
This ensures that people get incredibly frustrated when trying to access the services they’re entitled to. And many people simply give up out of this frustration.
Which is just great for the insurance company. They’ve saved money by not having to pay for your care.
State regulators are starting to take action, since the companies themselves have failed to do anything about this issue.
In California, regulators fined two insurance companies for overstating the breadth of their Obamacare networks in all specialties, not just psychiatry. A 2016 California law now requires Medi-Cal plans to update their online provider directories weekly.
Aetna recently settled with the state of Massachusetts after its attorney general launched an investigation into the company’s inaccurate network lists. Massachusetts legislators have introduced “An Act to Increase Consumer Transparency about Provider Networks” that would require insurers to keep updated and accurate lists of in-network providers.
What You Can Do To Stop This Unethical Practice
People are getting fed up with companies who don’t care, who pay lip service to care while severely limiting the availability and ready access to such care.
You can call or email your local state representative and senator to let them know this is an important issue to you, and that you’re frustrated by your insurance company’s inaccurate provider database.
You can also call the insurance company directly to express your frustration and upset. While they may not do much about it (especially if your insurance is provided to you by your employer), at least you’ve registered your complaint. If you pay for your own insurance, make sure they know that and that you’ll happily shop around for a new policy during the next open enrollment period if they don’t adequately address the issue.
Finally, if your insurance is paid for by your employer, let your HR department know about your challenges in finding a provider taking on new patients. You don’t have to go into any details (you can always say it’s for a family member, if you’re covered under a family plan). They may be able to apply pressure on the insurance company to get their database updated.
This is apparently a systematic, industry-wide problem. It may require legislation state-by-state in order to fix, as know insurance companies rarely do what’s in the public’s best interests unless their feet are held to the fire. And if they don’t act fast enough, I wouldn’t be surprised to see action taken at the federal level to ensure that people are getting what they paid for from their insurance provider.
Read the full article on Stat: Ghost networks of psychiatrists make money for insurance companies but hinder patients’ access to care