I had this exact experience in 2013 and 2014 with Cigna. I was given a list of providers and the vast majority, like 80%, were BS. A good number of them told me they didn’t even take Cigna. After that I had to scour reviews and websites and discovered that ZocDoc gave me far more accurate information on covered providers in my area accepting patients. Ridiculously more accurate. In fact I still use ZocDoc to find covered medical providers because there’s no other sane way to find them.
And I assure you, trying to find Medicare covered professionals, even for simple stuff like physical therapy, is a nightmare 20 times worse.
The 1996 parity act absolutely did not. it only covered annual & lifetime limits for group health plans. People were still denied care due to a “pre-existing condition”. There were no co-pays, and many, many large “private” insurance companies were still able to limit the number of yearly visits. As someone who (barely) lived through this in the 90s and most of the aughts, let’s be clear. The ACA required all insurers to cover mental health care exactly like regular preventive health care, with the same co-pay you’d pay to see your GP. And I can assure you this was an enormous improvement.
I too have had the experience of calling through a list of ghost providers. From a list of 120, I found exactly two who were willing to see me for an initial interview. One offered me an unidentified white powder at our first session. The other informed me at the end of the assessment that she would be billing me for her time since she had not yet accepted my insurance. These were Medicare providers, before 2016. I’m curious enough to ask for Medicare’s new “updated weekly” list & spend another couple of hours calling through it.
Ultimately it doesn’t end up mattering too much; I was alive through all that too, and I can assure you that the improvement was completely undetectable in my experience. I have insurance that ostensibly covers mental health care, and still don’t have access to mental healthcare.
I took two days off work where literally all I did was sit at my desk and call every in-network mental health provider within 200 miles of my house. There were 247 of them; 8 of them were actually doctors’ offices, 5 of them were willing to take new patients, but 3 of those were either a geriatric or pediatric specialist and won’t see me.
I tried both of the remaining two; they were both community centers, at one a counselor delayed my referral to a psychiatrist to discuss medication options, explicitly as a punitive measure for being late to an appointment.
The other wasn’t a counselor, or psychologist or psychiatrist but somehow had the authority to write prescriptions, and gave me some free samples of a drug that really seemed like it was helping. But when the free samples were gone, I discovered that it was a $200 a month medication (and that’s with insurance, it was nearly ten times as much without) and I don’t have $200 a month.
When I called to discuss other options, I never heard back. Had another appointment, where she boldly lied and said she had called me back and left a voice mail (she definitely didn’t, which I proved before leaving and never returning).
for many of us it did and does, even if it didn’t affect you directly. co-pays and true parity were a huge important step and continue to be in the fight agaibst stigma and for better care. regardless, you are correct that it remains extremely difficult to find quality mental health care, insured or not. long wait lists and lazy shit providers and many, many horror stories.
(please excuse my fat fingers today, disability making typing harder than usual)
Isn’t it a glorious triumph of the market when " Limited time only. Price and participation may vary by location." can be true of both fast food menu specials and potentially life critical healthcare services you are already paying someone to be contractually obligated to cover?
When I was in school I had good results with a group leader in training who was paired with my therapist. But she was contractually barred from “poaching” counseling center students.
Later they tried to tell me I should seek help “in the community”, but many of the community MSWs/PsyDs were not let out of these contracts.
Might have been a nurse practitioner- they have the authority to write prescriptions. The person I saw (and later got entangled with the fraud case in) was one of those.
In pediatrics, it is not so much “ghost networks” as just straight up absence of options. There is exactly one (1) psychiatrist in our area who will see kids. Not, mind you, a pediatric psych, but willing to do it, essentially as a community service. And if you can get in within 3-6 months you are doing well. You need to be able to travel a couple hours to get to an area with more options, but even there you are weeks to months waiting. We are forced to use the ED as our “psychiatrist” way too often.
I reported this same ghost network issue with Fidelis in NY. I had emergency surgery to remove a kidney stone, and then despite that they had dozens of urologists listed in their network, not one was real. I spent days calling to find a doctor who would remove my stent, and heard over and over, “We don’t take Fidelis and we’ve tried and tried to get off their list. They won’t remove us.” I reported to the state and they didn’t care.
