When I started my training in psychiatry, a senior doctor told me I should have a therapist of my own. He explained that it’s essential to understand myself so I can better understand my patients.

That made sense, so I started calling a list of psychiatrists who supposedly took my insurance. Some of them were dead. Many weren’t taking new patients. Others didn’t take my insurance. I couldn’t find a single psychiatrist on the list to see me. It took months of networking for me to finally find a therapist.

I later found out that my experience was commonplace, possibly deliberate, and that such inaccurate provider lists have a name: ghost networks or phantom networks.

advertisement

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.

My patients regularly tell me that this is not unique to Blue Cross Blue Shield and happens with most insurance providers. A 2016 survey by the Centers for Medicare and Medicaid Services showed that it’s also a problem with other medical specialties. The numbers, however, never seem as bad for other specialties as they do for psychiatry.

Maybe insurance companies don’t know their lists are inaccurate. Maybe they do but choose not to do anything about it. A more alarming possibility is that some companies intentionally keep the lists inaccurate to save money by preventing access to mental health care. After all, ghost networks benefit insurance companies: If it’s hard to find a provider who takes your insurance, it’s less likely you will access services that the insurer will have to pay for.

That concern may be founded, given other recently revealed strategies used by insurance companies to avoid paying for mental health. 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.”

No matter the reason, ghost networks are unacceptable.

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.

Ghost networks are particularly disturbing when it comes to Medicaid plans. States provide insurance companies with contracts to create plans for their poorest citizens. Though many of these companies are nonprofits, they often contract with for-profit companies to administer the mental health benefits. By failing to maintain accurate provider lists, these companies profit from taxpayer dollars while the most vulnerable mental health patients can’t find the care they need.

The outcomes have the potential to be devastating: an individual with severe depression who dies from suicide before he finds treatment, or someone with paranoid psychosis hurting herself because she never received access to effective medication.

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.

State-level progress is good, but this issue deserves national attention since it affects people across the country in all sociodemographic categories. It also should apply to both private and government-sponsored insurance plans.

Without access to appropriate mental health care, vulnerable people across the U.S. will continue to suffer, and some will die. Every insurance company should be required to keep its provider lists updated so they can’t collect premiums for services they don’t actually provide. Insurers should not profit because they have failed to make mental health care accessible.

Jack Turban, M.D., is a resident physician in psychiatry at Massachusetts General Hospital.

Leave a Comment

Please enter your name.
Please enter a comment.

  • I have been trying off and on to find a therapist for several years. I’m in Los Angeles where there are certainly as many shrinks as there are McDonald’s. I have failed over and over to even get a consultation. I have Excellent Insurance, probably close to if not the best in the state and I can’t get anyone to help me. I have been baffled by this problem. Thank you for shining a light on what I see now is yet another systemic fraudulent scheme being perpetrated by Big Insurance. Good on ya. ~MJ.

  • My experience was similar for years. I’m glad to say that my Kaiser Permanente Medicare plan in Northern California is really proactive in mental health access. I had only to mention it to my internist and I was set up with an appointment on the spot.

  • I cant imagine why the mother cited in this article would want to send her son to a psychiatrist be ause he was hearing voices. My daughter heears voices caused by a combination of trauma and recreation drug use. She lives peaceably at home after years of forced drugging and institutionalization The things that helped her the least were psychiatrists who are not versed in the humanities-anthropology-spirituality-philosophy-or psychology. They are not equipped to deal with people suffering from mental or emotional problems. They see everything through a biological lens and tend to get out the prescription pad after fifteen minutes. They fail to recognize or report adverse drug reactions and they have zero knowledge of deprescibing their clients. Many psychiatrists are not willing to take new clients who have been on psychiatric drugs for decades because they know that the they would only be treating past iatrogenic harm of the past psychiatrists. Calling for more access to psychiatry is like asking g for more gas to put out a wildfire. It would funny if it weren’t so deadly.

    • I think people look for psychiatrists at first because that is what they are told to do. You obviously have a lot of personal experience to have formed your views but remember, this is all really new for some.

  • I am a psychotherapist in the Washington DC area. Most psychiatrists around here do not take medical insurance. This creates such a problem for vulnerable patients who cannot pay the high fees charged by psychiatrists here that I consider this medical malpractice.

    • Then maybe you should put in the same blood, sweat, and tears we put into our professions and then not get paid for our work by the insurance companies. Thanks for opining its malpractice for us to not enjoy starving.

  • Another example of why insurance companies should be taken out of the health care equation. They decrease the quality of health care while increasing its cost.

  • Same is true of the podiatry specialty. Insurance companies limit specialized foot care by too narrow closed panels so that patients wait a month or more for new appointments which means loss of parts or entire feet in diabetic foot infections and wounds

  • This is not just among psychiatrists, Humana does the same thing with many medical providers. Some physician on their lists are deceased for 10 years. None of this is by accident, in many states corrupt politicians and state agencies take money from these big corporations, then lie and Gas Light the public.
    These huge corporations are just too corrupt and powerful. They prove that we need Universal Healthcare, like other developed nations. In my state the governor made millions working for an insurance company and protecting the industry in her previous job. She even hired her family members to take over her multi million dollar postition, when she took public office.

    These corporations target people in state agencies, and working in healthcare for states, offer them million dollar positions and then get away with murder. Large hospitals and nursing homes do the same thing, even hiring family members of the people working at state regulatory agencies.

    There was a time in this country when this would have been illegal or unethical, but this criminal behavior is normalized now. This appears to be killing people, ruining lives and increasing the levels of stress and despair, but no one is keeping track. Just look at how this is framed here, no indictments, no punishments, the real criminal never see jail time. They might get a token fine, nowhere near enough to cover the damage, and not even enough to curb the criminal behavior. California is the only state to even acknowledge this is happening, while no federal agencies did anything. In other states this is just fine, as long as they keep enough connected people on their payrolls.

  • We all need an ANON!! If only I was well enough to begin to apply your excellent suggestions.. I feel like I’m caving in..

  • It is my understanding that the insurance companies know their lists are not accurate but do try to make sure the list is updated. This is what I’ve done and seem to get pretty good results:

    send in an appeal, with the claim form from online filled out, the itemized bill from the provider with their NPI/Tax ID/Address/Provider names and making sure the bill has the CPT and ICD 10 codes on it, and a print of the online list where it shows the doctor being in network. I advise that in the appeal that you should be very adamant that you want the claim to be processed at the negotiated rates for the services rendered and that you want full payment reimbursed for what was in excess (so including the receipt of where they paid the provider) of the allowable amount (so in example, lets say the cost was $250, allowed amount was $45, so you want reimbursement of $205) otherwise threaten to make a call to the BOI because the list was not accurate.
    I have found shit gets done when the BOI is being threatened.

    oh and make sure to keep copies for your own records and put tracking on what you send to the insurance companies, that way if they argue you can say “according to this it was delivered.” I’d even dare say making it required to be signed so you can also hopefully get a name of who got the package.

  • In the dental provider community, a ghost network refers to passive PPO plans with a limited associated patient base; some literally have no patients under contract. At first glance, a ghost plan may look attractive but basically, they exist to capture providers into agreements to be leased to other carriers who then stack them to haunt multiple networks and reimburse participating dentists at the lowest rate between layered agreements.

Your daily dose of news in health and medicine

Privacy Policy