The "ghost networks" of mental health professionals that US health insurers rely on to deny care to their patients
jeudi 20 juin 2019, 15:55 , par BoingBoing
If you've decided to investigate treatment options for your mental health, your health insurer will cheerfully refer you to a list of hundreds of providers -- but as STAT's Jack Turban discovered, this 'network' of providers is actually a 'ghost network,' filled with wrong numbers that ring in McDonald's restaurants and jewelers. If you happen to reach an actual mental health professional, they'll probably tell you they're not accepting new patients.
An NIH study tried calling 360 in-network Blue Cross Blue Shield providers in Houston, Chicago, and Boston, with a 74% failure rate -- that is, only 26% of those numbers rang in the office of a provider who would make an appointment. For pediatric psychiatrists, the failure rate rises to 83%.
Maybe that's just a coincidence...but maybe not. A federal judge found that Unitedhealth was systematically, illegally gaming the system to deny mental health care to its insured customers in order to improve the company's profitability.
It's not hard to find a shrink who'll see you -- for $250/hour. But the for-profit health-care industry is signally uninterested in helping Americans take care of their mental health, and since people struggling with mental health issues are often easily discouraged (this is literally a symptom of depression), these hurdles are likely to be terrific money-spinners for the companies and their shareholders.
As Turban writes, 'Imagine realizing (or acknowledging) that you have depression — a defining feature of which is loss of motivation — and start looking for a psychiatrist. After calling a McDonald’s, a jewelry store, and providers who say they don’t take your insurance but will be happy to see you for $250 per hour that you must pay out of pocket, you’ll likely be inclined to give up.'
Friedman told me a story about a Massachusetts parent who struggled to find an in-network psychiatrist for her son who was hearing voices. Despite calling countless psychiatrists who supposedly took her insurance, she was unable to find one. One day before the 19-year-old got help, the police were called to the home because he locked himself in his room and was yelling. He struck a police office and was arrested.
Insurance companies are finally getting called on the carpet about ghost networks. 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.
Ghost networks of psychiatrists make money for insurance companies but hinder patients’ access to care [Jack Turban/STAT]
56 sources (32 en français)
mar. 19 janv. - 22:30 CET