Who are you going to call? Finance hopes not ghost networks
Senate committee study finds that 80 percent of listed mental health providers in directories are unreachable, not accepting new patients or not in-network
Patients seeking mental health treatment for themselves or their families too often find their insurers' provider directories riddled with inaccurate information, filled with names of providers who aren't accepting new patients or packed with contact information for providers who aren't actually accepting that form of insurance.
The problem of so-called "ghost networks" is pervasive in mental health, according to data released by Senate Finance Democrats ahead of a hearing Wednesday in which senators sharply criticized the accuracy of insurance company provider directories and called for action that would make it easier for patients to seek mental health care.
In the days leading up to Wednesday's hearing, Finance Committee staff called 120 mental health providers selected from 12 Medicare Advantage plans in six states and found that one-third of listings had incorrect numbers or inaccurate information or did not return the call.
In all, they found, 80 percent of the health providers listed were “ghosts” that were "unreachable, not accepting new patients or not in-network."
Staff were able to secure appointments only 18 percent of the time, although success varied by state. They were unable to schedule any appointments in Oregon, Finance Chair Ron Wyden’s home state.
“In a moment of national crisis about mental health, with the problems growing at such a rapid rate, the widespread existence of ghost networks is unacceptable,” said Wyden, a Democrat.
Wyden, who hinted at a January conference that tackling inaccurate ghost networks would be a committee priority, called for a three-pronged approach of oversight, greater transparency and enforcement to ensure these directories would be more reliable.
Ranking member Michael D. Crapo, R-Idaho, said strengthening provider directory accuracy is crucial to maximizing the potential of the committee’s previous bipartisan work on mental health.
Last December, Wyden and Sen. Tina Smith, D-Minn., introduced legislation to require insurers and the federal government to audits the directories to ensure they were regularly updated. The bill would have also required insurers to offer patients reimbursement if a provider is wrongly listed as in-network.
The duo is working to update that bill and aiming to reintroduce the updated version in the coming months, according to a Smith aide.
The oversight push comes amid a workforce crisis in mental health care and other specialties. The fiscal 2023 omnibus spending law includes language requiring Medicaid managed care plans to publish accurate, searchable provider directories.
Keris Jän Myrick, vice president of partnerships at Inseparable, a mental health advocacy group, testified she experienced issues with ghost networks firsthand in 2014 when she moved from California to work for the federal government in Washington, D.C.
She said she struggled to find a psychiatrist through Blue Cross Blue Shield's federal directory, testifying she spent "countless days and hours" scouring the network to find a provider.
Myrick suggested Congress implement a federally operated portal or hotline for consumers to report experiences with ghost networks and suggested the data could be used to guide policy or enforcement.
Mary Giliberti, chief public policy officer of Mental Health America, testified in favor of a “carrot and stick approach” that would incentivize plans that do well — and issue civil monetary penalties sufficient to change the behavior of noncompliant plans.
“If the directory isn't accurate, the consumer should pay in-network prices and their plan should cover the rest of that cost,” Giliberti told Wyden, adding that inaccurate listings contribute to stress that can exacerbate mental health problems.
Jack Resneck Jr., president of the American Medical Association, told Crapo that this is “one area where we actually need congressional help” with additional regulation.
“We hear from HHS that they think they don't have the tools to audit and enforce and impose monetary penalties on the MA plans and the exchange plans that they have oversight of,” said Resneck.
Resneck said that while it was not Finance Committee jurisdiction, the Department of Labor also needs additional authority for this oversight over ERISA plans. The AMA is working on the state level to ensure state insurance commissioners are granted similar authorities.
“If we don't have monetary penalties on these plans for continuing to put out these fake networks to make these fake directories to make their directors look bigger, then we are not going to make any progress,” Resneck said.
Robert Trestman, chair of psychiatry and behavorial medicine at the Virginia Tech Carilion School of Medicine Department of Psychiatry and Behavioral Medicine, called for Congress to pass a standard that could reduce inconsistencies in format, reporting time and sequence.
“If we had a standard, that would really reduce some of the challenges, sharing the burden between the physicians and the insurance plans,” he said.