The New York Attorney General Office issued a report on December 7, 2023 entitled “Inaccurate and inadequate:
Health plans’ mental health provider network directories” that stated: “Of the total 396 [mental health] providers called across all plans, callers were offered appointments with only 56 providers (14 percent). Therefore, 86 percent of the listed, in-network mental health providers staff called were ghosts, as they were unreachable, not in-network, or not accepting new patients.”
The Executive Summary contained in the report stated: “New Yorkers rely on health plan provider directories to access affordable, quality health care services. However, when provider directories contain inaccurate listings or unavailable providers — known as “ghost networks” — consumers often cannot access treatment using their health insurance benefits. As a result, they are forced to choose between paying out of pocket if they can or going without treatment, which can harm their health.
Using secret shopper surveys, numerous published studies have confirmed the existence of mental health provider ghost networks. To determine the scope of the problem in New York State, the Office of the Attorney General (OAG) conducted a statewide secret shopper survey of 13 health plans: Aetna, CDPHP, Cigna, Emblem, Empire BlueCross BlueShield, Excellus, Fidelis, Healthfirst, Independent Health, MetroPlus, Molina, MVP, and UnitedHealthcare. Staff reviewed directories from the plans, calling at least 20 providers in major cities served by the plans (New York City, Albany, Buffalo, and for one plan, Rochester). Callers attempted to schedule an appointment for an adult or child with a mental health provider who was listed in the directory as accepting new patients. The success rate for the 13 health plans surveyed ranged from 0 percent to 35 percent.
Ghost networks are illegal. New York and federal laws require that health plans maintain accurate provider directories. Ghost networks also suggest violations of laws requiring health plans to maintain adequate provider networks and cover mental health treatment the same way as physical health (“mental health parity”).”
New York Mental Health Crisis
Three million adult New Yorkers — one in five — live with mental illness. In February 2023, 31 percent of New Yorkers
reported symptoms of anxiety or depression. The COVID-19 pandemic dramatically increased the need for mental health services, but access to treatment remains out of reach for many. More than half of insured adults who do not get needed mental health treatment cite lack of coverage by their health plans as the reason. In 2022, 28.7 percent of New Yorkers with anxiety or depression reported an unmet need for counseling or therapy, which continues a disturbing trend. In 2019, 850,000 adults in New York (5.6 percent) had reported an unmet need for mental health treatment, including nearly 300,000 who reported not receiving care because of cost,
If you or a loved one may have been injured (or worse) as a result of mental health malpractice in New York or in another U.S. state, you should promptly find a mental health malpractice lawyer in New York, or in your state, who may investigate your mental health malpractice claim for you and represent you or your loved one in a mental health medical malpractice case, if appropriate.
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