The "ghost networks" of mental health professionals that US health insurers rely on to deny care to their patients

Originally published at: https://boingboing.net/2019/06/20/working-as-intended-3.html

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“ghost networks”

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We discussed “demonic networks” in another thread. Might be better applied here.

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I’m in the health care field. This is definitely a feature, not a bug, for the insurers. They are meticulous in knowing what provider and services they can not pay for, especially after the fact, but mysteriously lackadaisical in updating the public directories that locations and actual level of participation of providers, in order to create the appearance of a robust network but confusion to prevent patients from actually receiving care. Some of my info is ten years out of date on their sites and directories.
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They should solve this by passing a law that the provider network is not necessarily limited to those listed on the website, but the healthcare company is responsible in full for any charges from anyone listed on the website as an approved provider within 30 days of the service. The company is also fully liable for any charges from a previously approved provider until 30 days after the healthcare user is notified that the provider is no longer in the network. If the healthcare user is currently not in a state where they cannot be responsible for their actions (such as in a mental health care facility, in a comma, or otherwise incapacitated) or cannot move to a different facility (such as being in ICU for a serious accident or injury, ect) then the healthcare company is responsible for the costs of treatment until such individual is released from medical care.

Or, you know, single payer universal health care. That would be the best way of dealing with this.

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The very idea of networks is crazy. Insurers should be required to cover any licensed practitioner. Of course the system is the way it is by design.

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Other fun thing: when you call the company and ask what the patient’s benefits are, and they tell you, it’s still not a guarantee of payment. And if the insurance company gives inaccurate information, they don’t care, they’ll still refuse payment. We once called a company three times, consecutively, and got three different answers. Truly insane.

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At least in my area, many mental health providers (psychiatrists and therapists) are single practitioners or in a very small group practice, and most of these do not accept insurance of any kind, although they may have a sliding fee scale for patients who can’t afford their full regular fees. Accepting insurance practically means hiring a person to deal with the insurance companies: billing, fighting about authorization of treatment, and so on. Otherwise you’d be spending a big chunk of the hours you could be seeing patients doing that. So that is another reason why finding an in-network provider is hard: a whole bunch of practitioners have opted themselves out.

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People have died from this. It’s horrific.

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My brother is a counselor and the frustration of the patients with health insurance companies is completely on both sides. For most types of mental health care, no insurance companies cover it. For the care that is covered (preferentially psychiatrists who just write a prescription and send you on your way), its still a huge hassle for the providers.

On a more positive note, he just got this off the ground for anyone in NOLA looking for affordable (or free if necessary) mental health care.

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ETA: Everytime I see one of these posts, this meme shall suffer more.

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OK. I say there’s scope for right-minded philanthropic people to set up a simpler and more effective alternative with low, if any, profitability.

I was talking about micro-targetting of individuals these days. There’s no reason this all has to go the wrong way.

Maybe it’s always been this way, but it’s an unsurprising response to the ACA. The ACA required them to cover mental health at the same level as physical disease.

So they make it impossible to find help, and they make it harder to qualify for the care. I’m currently being treated for depression, and some third party reviews everything my therapist does and then they decide if I qualify for disability. I would like to focus on getting well; instead I worry about whether I’ll have to go back to the job that did this to me in the first place.

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My employer has an employee assistance plan, which covers certain things like crisis counseling for certain issues. I was referred to one after an incident, and while the counselor was good, there was no way I could continue with them, as they didn’t take my insurance. I got a similar run around trying to find one that would take my insurance, and after a series of shenanigans, turns out that there was fraud involved with the provider. :frowning:

the mental health care system in the us is barbaric, and broken even worse than the physical health care system.

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I can’t imagine how difficult this is for people seeking help for mental illness. I got very frustrated going through this for just a primary care provider when my insurance changed through work. It took 10 calls to reach an actual doctors office, and another 5 to reach one that was taking new patients. Then that physician changed practices less than a year later, and I had to start over.

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BCBS is government-run, right?

Apply Hanlon’s Razor.

I tried to start with EAP, but couldn’t find a single person in the EAP who was accepting new patients. Including multiple calls to the EAP provider to get names of people to call. I gave up and went straight to my insurance.

I called twenty people to find three that were current on the plan and accepting new patients. The first two were not good. The third was great but it took six months to find her. She goes on maternity leave Monday.

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It is not, as far as I know. It’s a collection of various public, individual and non-profit companies. They are involved in the administration of Medicare and provide some federal employee coverage, but I don’t believe they’re operated by the government.

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It wasn’t actually the ACA that did that, it was the Mental Health Parity Act of 1996.

But yes, before that, they were free to simply refuse to even consider covering mental health care, or else they would limit coverage to prescriptions and 6 office visits per calendar year, which is what my insurance used to do.

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“you’ll likely be inclined to give up.”
That about sums it up.

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